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DR. LUIS TICONA M.D.
NPI 1255693305
Internal Medicine in Boston, MA

Active since June 14, 2012PECOS EnrolledAccepts Medicare Assignment
801 MASSACHUSETTS AVE, CROSSTOWN 6B, BOSTON, MA 02118(617) 414-5951(617) 414-9201 Get Directions Write a Review

NPPES record last updated: November 24, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 24, 2019, May 15, 2019 (2 updates tracked since 2019).

About Dr. Luis Ticona M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LUIS TICONA M.D. (NPI 1255693305) is an individual internal medicine provider in Boston, Massachusetts, licensed in Massachusetts (262882) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS, is affiliated with Metrowest Medical Center, and is a graduate of Harvard Medical School (2012).

NPPES Registry Identity

NPI1255693305
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameDR. LUIS TICONACredential: M.D.
Location Address801 MASSACHUSETTS AVE, CROSSTOWN 6BBoston, MA 02118-2605
Mailing Address761 Worcester RdFramingham, MA 01701-5224 · (508) 872-3254
Phone(617) 414-5951
Fax(617) 414-9201
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 2012
Enumeration DateJune 14, 2012
Last NPPES UpdateNovember 24, 20192 updates tracked since enumeration
✔ NPI 1255693305 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Licenses✔ Licensed in MA · 262882✔ Licensed in MA · 251665
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
801 MASSACHUSETTS AVE, Boston, MA 02118
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Other Identifiers 1

Medicaid110104119AMA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Luis Ticona M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5294041216
PECOS Enrollment IDI20150904001071
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
36 services31 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
22 services22 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
18 services14 patients
Blood test, basic group of blood chemicals (calcium, total) 80048
A basic group blood test measures the levels of certain chemicals in your blood, including calcium. This helps assess your overall health and detect potential problems. The procedure involves drawing a small amount of blood from your arm, which is then analyzed in a lab.
16 services15 patients
Blood test, lipids (cholesterol and triglycerides) 80061
A lipid panel is a blood test that measures fats and fatty substances, such as cholesterol and triglycerides. These substances are used by your body as a source of energy. High levels can lead to health issues, including heart disease.
14 services14 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
12 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Metrowest Medical Center

Acute Care Hospitals · Framingham, MA
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number220175
Location115 Lincoln StreetFramingham, MA 01701 · Middlesex County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 02118 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$144.11 typical visit price
range $63.72 – $189.86
Typical copayment $36.02 (range $15.93 – $47.46)
Most-billed visit code 99204
Established Patient
$111.18 typical visit price
range $21.07 – $155.29
Typical copayment $27.79 (range $5.26 – $38.82)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Elevating leg rests, pair (for use with capped rental wheelchair base) K0195
DME-Wheelchairs · category DD021N
1 supplier14 claims14 services$6.15 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FELICIA ELIZABETH PATCH MD
Internal Medicine
801 MASSACHUSETTS AVE, CROSSTOWN 2
BOSTON, MA 02118
Suffolk County (617) 414-4376
CORINA ELENA BEINER MARTINEZ
Student in an Organized Health Care Education/Training Program
801 MASSACHUSETTS AVE
BOSTON, MA 02118
Suffolk County (617) 414-5951
MAYERLIN MORLA UBIERA
Counselor (Mental Health)
801 MASSACHUSETTS AVE
BOSTON, MA 02118
Suffolk County (617) 651-2538
XANTHIA ALIX TUCKER MD
Internal Medicine
801 MASSACHUSETTS AVE, SUITE 5A, CROSSTOWN BLDG
BOSTON, MA 02118
Suffolk County (617) 414-5951
DR. JENNIFER K HUGHES M.D.
Internal Medicine (Hospice and Palliative Medicine)
801 MASSACHUSETTS AVE, CROSSTOWN 2
BOSTON, MA 02118
Suffolk County (617) 414-4376
LUCY CURELL
Community Health Worker
801 MASSACHUSETTS AVE
BOSTON, MA 02118
Suffolk County (617) 991-8264
AMOS WU
Internal Medicine
801 MASSACHUSETTS AVE, CROSSTOWN 2
BOSTON, MA 02118
Suffolk County (617) 414-7399
MS. ARCHANA VASUDEVAN DO
Internal Medicine
801 MASSACHUSETTS AVE, CROSSTOWN 2
BOSTON, MA 02118
Suffolk County (617) 414-7399

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Luis Ticona's NPI number?

The NPI number for Luis Ticona is 1255693305. It was assigned to this individual provider in the NPPES registry on June 14, 2012.

Where is Luis Ticona located?

Luis Ticona practices at 801 Massachusetts Ave Crosstown 6B, Boston, MA 02118. The listed phone number is (617) 414-5951.

What is Luis Ticona's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Luis Ticona enrolled in Medicare?

Yes. Luis Ticona is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Luis Ticona accept?

Health plans from Anthem Blue Cross and Blue Shield list Luis Ticona as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Luis Ticona affiliated with any hospitals?

According to CMS data, Luis Ticona is affiliated with Metrowest Medical Center.

When was this NPI record last updated?

The NPPES record for Luis Ticona was last updated on November 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.