NPIMap

Carlos E Licon, M.D.

Individual provider Active NPI Family Medicine Physician · San Antonio, TX

NPI 1972689644 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1972689644
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
M4290 (TX)
Practice address
3750 Commercial Ave
San Antonio, TX 78221-3117
Phone
(210) 334-3760
Fax
(210) 923-6355
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 25

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.

Medicare Care Compare profile

Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
El Centro del Barrio Inc (18 clinicians)

Practice addresses (Care Compare)

6315 S Zarzamora St
San Antonio, TX 78211-3218
Phone (210) 922-7000

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20070222000720 TX Practitioner - Family Practice 4981706843 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
El Centro del Barrio Family Medicine Current
since Feb 19, 2026		 Accepting new patients
BHS Physicians Network, Inc Current
since Dec 1, 2015		 Accepting new patients
BHS Physicians Network, Inc Family Medicine Current
since Dec 1, 2015		 Accepting new patients
El Centro del Barrio, Inc. Past Accepting new patients

Locations

6315 S Zarzamora St
San Antonio, TX 78211
Phone (210) 924-9254

3903 Wiseman Blvd
San Antonio, TX 78251
Phone (210) 681-0126

3750 Commercial Ave
San Antonio, TX 78221
Phone (210) 334-3700

9011 Poteet Jourdanton Fwy
San Antonio, TX 78224
Phone (210) 928-4900

8230 N Loop 1604 W
San Antonio, TX 78249
Phone (210) 239-0495

3903 Wiseman Blvd
Ste 100
San Antonio, TX 78251
Phone (210) 681-0126

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M4290 TX Yes

Addresses

Primary practice location

3750 Commercial Ave
San Antonio, TX 78221-3117

Mailing address

3750 Commercial Ave
San Antonio, TX 78221-3117
Phone (210) 334-3700

Other identifiers

IdentifierTypeStateIssuer
184983801MedicaidTX
X0148767OtherTXDPS
8G8247OtherTXBCBS
94846OtherTXCARELINK

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972689644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782213117",
            "telephone_number": "210-334-3700",
            "fax_number": "210-922-0162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 COMMERCIAL AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782213117",
            "telephone_number": "210-334-3760",
            "fax_number": "210-923-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICON",
        "first_name": "CARLOS",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M4290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184983801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS",
            "identifier": "X0148767",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8G8247",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARELINK",
            "identifier": "94846",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

All providers in San Antonio, TX · Family Medicine Physician in Texas

Sources for this page

Verify at the official NPI Registry.