Jordan Licata, DO

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

5294 Issued in TN

Practice address

1821 N Washington St
Tullahoma, TN 37388-2221

Phone

(931) 461-5056

Fax

(931) 455-4450

NPI assigned

Mar 26, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

Otolaryngology

Education

Philadelphia College of Osteopathic Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marvel Clinic P.C.Group PAC ID 0547454811, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southern Tennessee Regional Health System Winchest Hospital, Winchester, TN, CCN 440058

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Marvel Clinic P.C.

  • Specialist
  • Tullahoma, TN
  • NPI 1760487086
  Medicare reassignment Care Compare group NPD
• Integrated Facial Aesthetics, PLLC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Tullahoma, TN
  • NPI 1689526741
  Medicare reassignment NPD
• Center for Day Surgery

  • Ambulatory Surgical Clinic/Center
  • Tullahoma, TN
  • NPI 1881699106
  NPD
• Western University of Health Sciences

  • Adult Medicine Physician
  • Lebanon, OR
  • NPI 1639555170
  NPD (past)

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

• Southern Tennessee Medical Center LLC

  • General Acute Care Hospital
  • Winchester, TN
  • NPI 1467408781
  Care Compare affiliation

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1952795106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 N WASHINGTON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882221",
            "telephone_number": "931-461-5056",
            "fax_number": "931-455-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 N WASHINGTON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882221",
            "telephone_number": "931-461-5056",
            "fax_number": "931-455-4450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1011 S Main St",
            "address_purpose": "LOCATION",
            "city": "Hopkinsville",
            "state": "KY",
            "postal_code": "422402009",
            "country_code": "US",
            "telephone_number": "270-881-1525",
            "fax_number": "270-886-3802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICATA",
        "first_name": "JORDAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "KY",
            "license": "05799",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "5294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailey Leemkuil
• Anna Katherine Lemmons, PT, DPT
• L Michelle Leone, O.T.R.
• Ronald Terry Leverette, D. PH.
• Kent E Lewis, D MIN
• Life Care Centers of America, Inc.
• Lifeaid Medical Equipment LLC
• Haley Limbaugh
• C. Michael Locke, D.M.D., M.D.
• John Logan

• Otolaryngology Physician in Tullahoma, TN
• Providers in Tullahoma, TN by specialty
• Otolaryngology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.