Wade K.C. Licup, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A179911 Issued in CA

Practice address

130 Cedar Rd
Vista, CA 92083-5102

Phone

(760) 806-5500

NPI assigned

Apr 8, 2019

Last updated

Apr 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advantage Health Systems Home health agency, San Diego, CA, CCN 058355
• Seaport Scripps Home Health Home health agency, San Diego, CA, CCN 057602
• Scripps Memorial Hospital - Encinitas Hospital, Encinitas, CA, CCN 050503
• Scripps Green Hospital Hospital, La Jolla, CA, CCN 050424

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Scripps Health

  dba Scripps Clinic

  • Multi-Specialty Clinic/Center
  • La Jolla, CA
  • NPI 1275899072

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Regents of the University of California

  dba UCLA Entertainment Ind MedGrp

  • Internal Medicine Physician
  • Glendale, CA
  • NPI 1891110888

  Family Medicine

  Medicare reassignment NPD
• The Regents of the University of California

  dba UCLA Dept of Medicine

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1235107566

  Family Medicine

  Medicare reassignment NPD
• Regents of the University of California

  dba UCLA Entertainment Ind Medgrp

  • Durable Medical Equipment & Medical Supplies
  • Woodland Hills, CA
  • NPI 1083063127
  NPD
• Scripps Health

  dba Scripps Home Health Care Services

  • Home Health Agency
  • San Diego, CA
  • NPI 1578556114
  NPD
• Scripps Health

  dba Scripps Memorial Hospital La Jolla

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841277704
  NPD
• Scripps Health

  dba Scripps Coastal Medical Center

  • Family Medicine Physician
  • San Diego, CA
  • NPI 1881636108
  NPD
• The Regents of the University of California

  dba UCLA Dept of Medicine

  • Ambulatory Surgical Clinic/Center
  • Valencia, CA
  • NPI 1689200305
  NPD
• Scripps Clinic Medical Group

  • Multi-Specialty Clinic/Center
  • San Diego, CA
  • NPI 1124003280
  NPD (past)
• Scripps Health

  • Clinical Medical Laboratory
  • La Jolla, CA
  • NPI 1427034990
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Advantage Health Systems

  • Home Health Agency
  • San Diego, CA
  • NPI 1538225313
  Care Compare affiliation
• Rancho Bernardo Healthcare LLC

  dba Seaport Scripps Home Health

  • Home Health Agency
  • San Diego, CA
  • NPI 1750906954
  Care Compare affiliation
• Scripps Health

  dba Scripps Memorial Hospital Encinitas

  • General Acute Care Hospital
  • Encinitas, CA
  • NPI 1700829199
  Care Compare affiliation
• Scripps Health

  dba Scripps Green Hospital

  • General Acute Care Hospital
  • La Jolla, CA
  • NPI 1841233780
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1881157998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "760-806-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CEDAR RD",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920835102",
            "telephone_number": "760-806-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Mercy Ave",
            "address_purpose": "LOCATION",
            "city": "Merced",
            "state": "CA",
            "postal_code": "953408319",
            "country_code": "US",
            "telephone_number": "209-564-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4560 Admiralty Way Ste 100",
            "address_purpose": "LOCATION",
            "city": "Marina Del Rey",
            "state": "CA",
            "postal_code": "902925424",
            "country_code": "US",
            "telephone_number": "310-827-3700",
            "fax_number": "310-578-5379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICUP",
        "first_name": "WADE",
        "middle_name": "K.C.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A179911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris E Lewis
• Maya Lewis
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• Xiangli Li, M.D. PH.D., PC
• Sharon Liao, LAC., OMD., PHD
• Georgette Young Liebhaber, L.AC.
• Life Saver Home Care & Wheelchair Transport Inc (Life Saver)
• Life Saver in-Home Support Services
• Liliane Shepard (Business Park Dental)
• Steve Lim, LCSW

• Family Medicine Physician in Vista, CA
• Providers in Vista, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.