JORDAN LICATA DO
NPI 1952795106
Otolaryngology in Tullahoma, TN

Q: What is Jordan Licata's NPI number?

The NPI number for Jordan Licata is 1952795106. It was assigned to this individual provider in the NPPES registry on March 26, 2015.

Q: What is Jordan Licata's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Jordan Licata was last updated on December 12, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.

Active since March 26, 2015PECOS EnrolledAccepts Medicare Assignment

1821 N WASHINGTON ST, TULLAHOMA, TN 37388(931) 461-5056(931) 455-4450 Get Directions Write a Review

NPPES record last updated: December 12, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Dec 12, 2024, Nov 22, 2024 (2 updates tracked since 2024).

On this page

About Jordan Licata Do NPPES

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

JORDAN LICATA DO (NPI 1952795106) is an individual otolaryngology provider in Tullahoma, Tennessee, licensed in Tennessee (5294) and active in the NPI registry since March 2015. He is enrolled in Medicare PECOS, maintains a secondary practice location in Hopkinsville, and is a graduate of Philadelphia College Of Osteopathic Medicine (2023).

NPPES Registry Identity

NPI1952795106

Entity TypeIndividualMale

Primary Taxonomy207Y00000X

Provider Legal NameJORDAN LICATACredential: DO

Location Address1821 N WASHINGTON STTullahoma, TN 37388-2221

Mailing Address1821 N Washington StTullahoma, TN 37388-2221 · (931) 461-5056 · Fax (931) 455-4450

Phone(931) 461-5056

Fax(931) 455-4450

Sole ProprietorNo

Medical School CMSPhiladelphia College Of Osteopathic MedicineGraduated 2023

Enumeration DateMarch 26, 2015

Last NPPES UpdateDecember 12, 20242 updates tracked since enumeration

NPPES CertifiedDecember 12, 2024

✔ NPI 1952795106 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians

Taxonomy Code207Y00000X

Licenses✔ Licensed in TN · 5294✔ Licensed in KY · 05799

Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

1821 N WASHINGTON ST, Tullahoma, TN 37388

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Secondary Practice Location 1

Location 11011 S Main StHopkinsville, KY 42240-2009 · Phone (270) 881-1525 · Fax (270) 886-3802

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jordan Licata Do 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 ID1254788912

PECOS Enrollment IDI20231117000720

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.

Medicare Billing Reassignments

Medicare enrollment records show Jordan Licata reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Integrated Facial Aesthetics, PLLC

Same address

Otolaryngology/Facial Plastic Surgery

1821 N WASHINGTON ST
Tullahoma, TN 37388

Reassigned Medicare billing, Tennessee enrollment
5 clinicians in this Medicare group

NPI 1689526741 (931) 455-2005

Marvel Clinic P.C.

Same address

Specialist

1821 N WASHINGTON ST
Tullahoma, TN 37388

Reassigned Medicare billing, Tennessee enrollment
8 clinicians in this Medicare group

NPI 1760487086 (931) 455-2005

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37388 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

$121.80 typical visit price

range $52.64 – $160.89

Typical copayment $30.45 (range $13.16 – $40.22)

Most-billed visit code 99204

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

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.

LONNIE SCHOLL PA-C

Physician Assistant