NPIMap

Organization Active NPI

Legacy Primary Health LLC

  • Family Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1124998711
Registry record updated Nov 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LEGACY PRIMARY HEALTH LLC
Practice address
5165 Northland Dr NE
Grand Rapids, MI 49525-1015
Phone
(843) 990-1965
NPI assigned
Nov 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2025

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

Authorized official

Name
Vanessa StevensNPI 1023867843
Title
Manager
Phone
(843) 990-1965

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

5165 Northland Dr NE
Grand Rapids, MI 49525-1015

Mailing address

5165 Northland Dr NE
Grand Rapids, MI 49525-1015

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1762473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762473600000",
    "number": "1124998711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5165 NORTHLAND DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5165 NORTHLAND DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251015",
            "telephone_number": "843-990-1965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PRIMARY HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-07",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "843-990-1965"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.