DR. JELENA A LICINA (MD) – Internal Medicine Physician, NPI 1316921687
Internal Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
2,994 INTERNAL MEDICINE in CO
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Provider Addresses for DR. JELENA A LICINA (MD)
Avista Adventist Campus, 100, Health Park Drive, Louisville, Boulder County, Colorado, 80027, United States
LOUISVILLE, CO 800279583
Phone: (303) 643-1159
Fax: (720) 874-5886
Type: Mailing
10350 E Dakota Ave
Denver, CO 802471314
Phone: (303) 338-4545
Type: Location
1700 UNIVERSITY AVE W
SAINT PAUL, MN 551043727
Phone: (651) 232-1123
Fax: (651) 232-5700
Type: Mailing
1575 BEAM AVE
MAPLEWOOD, MN 551091126
Phone: (651) 232-2000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-03-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120515000667 | I | Internal Medicine | CO | TBD |
| I20240307000820 | I | Internal Medicine | TN | TBD |
| I20250313002329 | I | Internal Medicine | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 80027)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | NC | |
| Family Practice, Hospitalist | WA | |
| Internal Medicine | TX | |
| Internal Medicine, Hospitalist | WA | |
| Nurse Practitioner | TX | |
| Family Practice | NM | |
| Family Practice | ID | |
| Internal Medicine | WA | |
| Nurse Practitioner | TX | |
| Hospitalist, Internal Medicine | WV |
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