NPIMap

Organization Active NPI

Legacy Path LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • South Bend, IN
National Provider Identifier
1205693728
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
LEGACY PATH LLC
Practice address
3355 Douglas Rd
South Bend, IN 46635-1779
Phone
(574) 234-4176
NPI assigned
Mar 1, 2024
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Terry Pipp
Title
Cfo
Phone
(800) 288-8325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

3355 Douglas Rd
South Bend, IN 46635-1779

Mailing address

PO Box 10961
Fort Wayne, IN 46855-0961
Phone (800) 288-8325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240604002377 IN Part B Supplier - Clinic/Group Practice 5890237960 Receives reassigned benefits from 18 practitioners
Practice locations: Elkhart, IN; Logansport, IN; Mishawaka, IN; South Bend, IN
O20240606001945 MI Part B Supplier - Clinic/Group Practice 5890237960 Receives reassigned benefits from 18 practitioners
Practice locations: Kalamazoo, MI

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1709251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1205693728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10961",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468550961",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS RD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351779",
            "telephone_number": "574-234-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PATH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-01",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "PIPP",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "800-288-8325"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.