Legacy Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LEGACY DERMATOLOGY PLLC

Practice address

2230 Huntington Dr N
Algonquin, IL 60102-4419

Phone

(415) 802-1310

Fax

(847) 960-3675

NPI assigned

Dec 29, 2022

Organization subpart

No

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

Authorized official

Name

Laurence Bradley, MDNPI 1639516313

Title

MD/Owner

Phone

(415) 802-1310

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laurence Martin Bradley Jr., M.D.

  • Dermatology Physician
  • Algonquin, IL
  • NPI 1639516313
  Medicare reassignment Care Compare group NPD Authorized official
• Emily Ann Berry, PA-C

  • Physician Assistant
  • Carbondale, IL
  • NPI 1053290114
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1672272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1053024554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 HUNTINGTON DR N",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601024419",
            "telephone_number": "847-603-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 HUNTINGTON DR N",
            "city": "ALGONQUIN",
            "state": "IL",
            "postal_code": "601024419",
            "telephone_number": "415-802-1310",
            "fax_number": "847-960-3675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-29",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "415-802-1310",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don A Larson, PA-C
• Joseph Lawler
• Cort Daniel Lawton, M.D.
• Evan Lefelstein, DMD
• Legacy Counseling and Recovery
• Suzanne Leigh
• Elvie J Lenth, PT
• Stephanie Nicole Leverentz, PA-C
• Life Star Medical Supplies
• Lifestar Medicar

• Dermatology Physician in Algonquin, IL
• Providers in Algonquin, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.