LICEMEE MBAMA-MPOLO
NPI 1285401687
Nurse Practitioner - Family in Rochester, NY

Q: What is Licemee Mbama-mpolo's NPI number?

The NPI number for Licemee Mbama-mpolo is 1285401687. It was assigned to this individual provider in the NPPES registry on December 6, 2023.

Q: What is Licemee Mbama-mpolo's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since December 06, 2023PECOS Enrolled

1415 PORTLAND AVE STE 245, ROCHESTER, NY 14621(585) 922-4496(585) 922-4442 Get Directions Write a Review

NPPES record last updated: April 8, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 8, 2026, Mar 23, 2026, Dec 6, 2023 (3 updates tracked since 2023).

On this page

About Licemee Mbama-mpolo NPPES

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

LICEMEE MBAMA-MPOLO (NPI 1285401687) is an individual family provider in Rochester, New York, licensed in New York (355355) and active in the NPI registry since December 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1285401687

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameLICEMEE MBAMA-MPOLO

Location Address1415 PORTLAND AVE STE 245Rochester, NY 14621-3022

Mailing Address100 Kings Hwy SRochester, NY 14617-5504

Phone(585) 922-4496

Fax(585) 922-4442

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateDecember 6, 2023

Last NPPES UpdateApril 8, 20263 updates tracked since enumeration

NPPES CertifiedApril 8, 2026

✔ NPI 1285401687 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in NY · 355355

Also ListedRegistered Nurse · Maternal NewbornTaxonomy 163WM0102X · License 797276 (NY)

1415 PORTLAND AVE STE 245, Rochester, NY 14621

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Licemee Mbama-mpolo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6901375344

PECOS Enrollment IDI20260515000330

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14621 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

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

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.

Other Providers at the Same Location NPPES 13

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

EVA WALL MD

Surgery