JORDAN LICATA (DO) – Otolaryngology Physician, NPI 1952795106
Otolaryngology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
182 OTOLARYNGOLOGY in OR
Provider Addresses for JORDAN LICATA (DO)
200 MULLINS DR
LEBANON, OR 973553983
Phone:
Type: Mailing
1011 S Main St
Hopkinsville, KY 422402009
Phone: (270) 881-1525
Fax: (270) 886-3802
Type: Location
1821 N WASHINGTON ST
TULLAHOMA, TN 373882221
Phone: (931) 461-5056
Fax: (931) 455-4450
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 15 Open Payments records for all available years, with a total value of $1,834.
Total Amount is formed as General ($1,834) + Research ($0) + Ownership ($0) = $1,834.
Last reported payment date: 2024-08-22 • Largest payer in this snapshot: Stryker Corporation ($1,467).
Total Amount
$1,834
General + Research + Ownership
Payments
15
Total payment records
General Amount
$1,834
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Stryker Corporation | $1,467 |
| AERIN MEDICAL INC. | $207 |
| Smith+Nephew, Inc. | $117 |
| Integra LifeSciences Corporation | $43 |
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: 2023-11-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20231117000720 | I | Otolaryngology | TN | 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 97355)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | TN | |
| - | TN | |
| Certified Registered Nurse Anesthetist (Crna) | TX | |
| Physician Assistant | TN | |
| - | TN | |
| - | TN |
Reviews
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