NPIMap

Organization Active NPI

Legacy Medical Care Inc

  • Federally Qualified Health Center (FQHC)
  • East Dundee, IL
National Provider Identifier
1003365412
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEGACY MEDICAL CARE INC
Practice address
519 Dundee Ave
East Dundee, IL 60118-1642
Phone
(847) 749-2248
NPI assigned
Sep 26, 2016
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Melissa Donorio, RN
Title
Ceo
Phone
(847) 749-2248

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X IL Primary

Addresses

Primary practice location

519 Dundee Ave
East Dundee, IL 60118-1642

Mailing address

151 Dundee Ave Ste C
East Dundee, IL 60118-1649
Phone (847) 844-3274

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170724000423 IL Part A Provider - Federally Qualified Health Center (FQHC) 7416183298 Practice locations: East Dundee, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003365412. Details of each certification follow.

Federally qualified health center certification: CCN 781878

Legal name
LEGACY MEDICAL CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 24, 2017
Last certification
Jul 24, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 2013 in IL
Enrollment address
519 Dundee Ave
East Dundee, IL 60118-1642

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Legacy Medical Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFECA

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Klaus Boettcher Individual OtherChairman Jun 20, 2017
Maria Alvarez Individual OtherBoard Member Jun 20, 2017
Soontaree Lathitham Individual OtherBoard Member Jun 20, 2017
Andrew Kammes Individual OtherBoard Member Jun 20, 2017
John Bruce Individual OtherTreasurer Jun 20, 2017
Jordan Alan Randall Davis Individual OtherBoard Member Oct 20, 2017
Melissa D'Onorio Individual Operational/Managerial ControlCeo Jun 20, 2017
Benito Gomez Individual OtherBoard Member Jun 20, 2017
Erik Gasca Individual OtherBoard Member Jun 20, 2017

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1003365412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 DUNDEE AVE STE C",
            "city": "EAST DUNDEE",
            "state": "IL",
            "postal_code": "601181649",
            "telephone_number": "847-844-3274",
            "fax_number": "847-844-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 DUNDEE AVE",
            "city": "EAST DUNDEE",
            "state": "IL",
            "postal_code": "601181642",
            "telephone_number": "847-749-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "DONORIO",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-749-2248",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Dundee, IL

Sources for this page

Verify at the official NPI Registry.