Legacy Medical Care Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · East Dundee, IL
NPI 1003365412 · NPPES record last updated May 13, 2026
Key facts
- NPI
- 1003365412
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Melissa Donorio, RN
- Title
- Ceo
- Phone
- (847) 749-2248
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 2
Practitioners 1
-
Amy K Hill, LCPC, CADC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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
- Corporation · Non-profit
- Incorporated
- Jul 17, 2013 in IL
- Enrollment address
- 519 Dundee Ave
East Dundee, IL 60118-1642
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Klaus Boettcher |
Other |
Jun 20, 2017 | |
| Maria Alvarez |
Other |
Jun 20, 2017 | |
| Soontaree Lathitham |
Other |
Jun 20, 2017 | |
| Andrew Kammes |
Other |
Jun 20, 2017 | |
| John Bruce |
Other |
Jun 20, 2017 | |
| Jordan Alan Randall Davis |
Other |
Oct 20, 2017 | |
| Melissa D'Onorio |
Operational/Managerial Control |
Jun 20, 2017 | |
| Benito Gomez |
Other |
Jun 20, 2017 | |
| Erik Gasca |
Other |
Jun 20, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170724000423 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 7416183298 | Practice locations: East Dundee, IL |
National Provider Directory
- Tax ID family
- Legacy Medical Care
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BGFECA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | IL | Yes |
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
Other providers in East Dundee, IL
- Inspired Grace Healthcare Inc
- Inspired Grace Healthcare, Inc
- Inspired Grace Healthcare, Inc
- Alexis Kaul
- La Vida Pharmacy Inc
- Lawrence Lerner
- Gary R Lewison
- Lifeline Pharmacy, Inc
- Steven P Loheide
- Main Street Dental P.C.
All providers in East Dundee, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.