Mark R Licht (NPI# 1306841473, PAC ID# 6800999293) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1306841473 |
| PAC ID by PECOS | 6800999293 |
| Professional Enrollment ID | I20070305000499 |
| Full Name | Mark R Licht |
| Organization Legal Name | NORTH BREVARD MEDICAL SUPPORT INC |
| Address |
825 Century Medical Dr Titusville FL 32796-2113 |
| Phone Number | 3215674991 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY |
| Graduation Year | 1988 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 7618870296 |
| Number of Group Practice Members | 59 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100028 | PARRISH MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 825 Century Medical Dr, Titusville, FL 32796-2113 | 3215674991 | NORTH BREVARD MEDICAL SUPPORT INC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_047_overall | Care Plan | 6% | |
| MIPS_EC_047_overall | Care Plan | 6% | |
| MIPS_EC_238_2+ | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% | |
| MIPS_EC_238_2+ | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% | |
| MIPS_EC_238_overall | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% | |
| MIPS_EC_238_overall | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% |
| Organization Legal Name | NORTH BREVARD MEDICAL SUPPORT INC |
| Physicians | 51 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Khalid George | Gastroenterology | North Brevard Medical Support Inc | 825 Century Medical Dr, Titusville, FL 32796-2113 |
| Dixitkumar Modi | Family Medicine | North Brevard Medical Support Inc | 390 Challenger Rd, Cape Canaveral, FL 32920-4200 |
| Rachel M Loeffler | Nurse Practitioner | North Brevard Medical Support Inc | 5005 Port St John Pkwy, Suite 2400, Port St John, FL 32927-4305 |
| Cara Starkey | Certified Nurse Midwife (cnm) | North Brevard Medical Support Inc | 494 N Washington Ave, Titusville, FL 32796-2871 |
| Pamela S Tronetti | Geriatric Medicine | North Brevard Medical Support Inc | 805 Century Medical Dr A, Titusville, FL 32796-2100 |
| Vidya N Hate | Obstetrics/gynecology | North Brevard Medical Support Inc | 250 Harrison St, Titusville, FL 32780-5026 |
| Patricia A Alexander | Family Medicine | North Brevard Medical Support Inc | 250 Harrison St, Titusville, FL 32780-5026 |
| Dawn Hillebrandt | Nurse Practitioner | North Brevard Medical Support Inc | 250 Harrison St, Titusville, FL 32780-5026 |
| Arvind D'cruz | Neurology | North Brevard Medical Support Inc | 951 N Washington Ave, Titusville, FL 32796-2159 |
| Benjamin Nettleton | Family Medicine | North Brevard Medical Support Inc | 951 N Washington Ave, Titusville, FL 32796-2163 |
| Street Address |
825 CENTURY MEDICAL DR |
| City | TITUSVILLE |
| State | FL |
| Zip | 32796-2113 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Khalid George | Gastroenterology | North Brevard Medical Support Inc | 825 Century Medical Dr, Titusville, FL 32796-2113 |
| Sherry L Riley | Nurse Practitioner | North Brevard Medical Support Inc | 825 Century Medical Dr, Titusville, FL 32796-2113 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sarah Slone | Nurse Practitioner | Moore Medical Group Inc | 2355 Truman Scarborough Way, Palm Point Behavioral Health, Titusville, FL 32796-1310 |
| Eric A Moore | Family Medicine | Moore Medical Group Inc | 2355 Truman Scarborough Way, Palm Point Behavioral Health, Titusville, FL 32796-1310 |
| Mayra A Abelleira Martinez | Psychiatry | 2355 Truman Scarborough Way, Attn Cfo, Titusville, FL 32796-1310 | |
| Ismael A Beloso | Family Medicine | Moore Medical Group Inc | 2355 Truman Scarborough Way, Palm Point Behavioral Health, Titusville, FL 32796-1310 |
| Charles Ikegwuonu | Nurse Practitioner | Moore Medical Group Inc | 2355 Truman Scarborough Way, Palm Point Behavioral Health, Titusville, FL 32796-1310 |
| Laura Kn Powell | Nurse Practitioner | Moore Medical Group Inc | 2355 Truman Scarborough Way, Palm Point Behavioral Health, Titusville, FL 32796-1310 |
| Debra Kay Allen | Nurse Practitioner | Indian River Medical Office Pa | 3300 Dairy Rd, Titusville, FL 32796-1512 |
| Aluino L Ochoa | Internal Medicine | Indian River Medical Office Pa | 3300 Dairy Rd, Titusville, FL 32796-1512 |
| Cheryl M Gardner | Nurse Practitioner | Indian River Medical Office Pa | 3300 Dairy Rd, Titusville, FL 32796-1512 |
| Kimberly E Lundquist | Nurse Practitioner | Indian River Medical Office Pa | 3300 Dairy Rd, Titusville, FL 32796-1512 |
| Find all physicians in zip 32796 | |||
| City | TITUSVILLE |
| Zip Code | 32796 |
| Specialty | UROLOGY |
| City + Specialty | TITUSVILLE + UROLOGY |
Please comment or provide details below to improve the information on Mark R Licht.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.