NPIMap

Organization Active NPI

Legacy MD Medical Group Inc

  • Cardiac Rehabilitation Registered Nurse
  • Calexico, CA
National Provider Identifier
1285494351
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiac Rehabilitation Registered NurseTaxonomy code 163WC3500X
Legal business name
LEGACY MD MEDICAL GROUP INC
Practice address
222 E Cole Blvd
Calexico, CA 92231-3211
Phone
(760) 550-1685
Fax
(442) 615-2060
NPI assigned
Mar 19, 2024
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LEGACY MD MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
John Marshall Strong, MDNPI 1043248719
Title
President
Phone
(760) 550-1685

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
Cardiac Rehabilitation Registered Nurse 163WC3500X NU Primary

Addresses

Primary practice location

222 E Cole Blvd
Calexico, CA 92231-3211

Mailing address

222 E Cole Blvd
Calexico, CA 92231-3211
Phone (760) 550-1685

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240806001131 CA Part B Supplier - Intensive Cardiac Rehabilitation 0446619738 Receives reassigned benefits from 4 practitioners
Practice locations: Calexico, CA; El Centro, CA

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Legacy MD Medical Group Inc3 organizations share this tax ID, including this one
Part of
Legacy MD Medical Group Inc

Other organizations with this tax ID 2

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

Locations

222 E Cole Blvd
Ste C
Calexico, CA 92231
Phone (760) 352-2551

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1285494351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 E COLE BLVD",
            "city": "CALEXICO",
            "state": "CA",
            "postal_code": "922313211",
            "telephone_number": "760-550-1685",
            "fax_number": "442-615-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 E COLE BLVD",
            "city": "CALEXICO",
            "state": "CA",
            "postal_code": "922313211",
            "telephone_number": "760-550-1685",
            "fax_number": "442-615-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MD MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEGACY MD MEDICAL GROUP INC",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "STRONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-550-1685",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calexico, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.