NPIMap

Organization Active NPI

Legacy Physiatry Group LLC

  • Physical Medicine & Rehabilitation Physician
  • Plano, TX
National Provider Identifier
1316078769
Registry record updated Oct 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
LEGACY PHYSIATRY GROUP LLC
Practice address
850 Central Pkwy E Ste 275
Plano, TX 75074-5542
Phone
(972) 881-4688
Fax
(972) 668-5401
NPI assigned
Mar 8, 2007
Reactivated
Jul 30, 2013
Last updated
Oct 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2017

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

Authorized official

Name
Venkatesh Lakshman, MD
Title
Owner/President
Phone
(972) 881-4688

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

850 Central Pkwy E Ste 275
Plano, TX 75074-5542

Mailing address

850 Central Pkwy E
Suite 275
Plano, TX 75074
Phone (972) 881-4688

Other identifiers 3

IdentifierTypeStateIssuer
203548702MedicaidTX
D07564OtherTXRAILROAD MEDICARE PALMETTO GBA
203548701MedicaidTX

Other names 1

  • Legacy Physiatry Group LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070907000584 TX Part B Supplier - Clinic/Group Practice 1759353519 Receives reassigned benefits from 106 practitioners
Practice locations: Lake Worth, TX; Lancaster, TX; Liberty, TX; McKinney, TX; Mesquite, TX; Plano, TX; Richland Hills, TX; Rockwall, TX…
O20141014000387 FL Part B Supplier - Clinic/Group Practice 1759353519 Receives reassigned benefits from 37 practitioners
Practice locations: Lake Mary, FL; Coconut Creek, FL

National Provider Directory

National Provider Directory

Locations

11811 N Tatum Blvd
Ste 3031
Phoenix, AZ 85028
Phone (480) 589-2890

5493 Wiles Rd
Ste 106
Coconut Creek, FL 33073
Phone (321) 214-4530

2645 W Randol Mill Rd
Arlington, TX 76012
Phone (817) 277-6789

2244 Brinker Rd
Denton, TX 76208
Phone (940) 289-3268

201 Sycamore School Rd
Ft Worth, TX 76134
Phone (817) 293-7610

6113 Jack Finney Blvd
Greenville, TX 75402
Phone (903) 455-7942

4200 Shepherd Ln
Mesquite, TX 75180
Phone (972) 286-0335

Practitioners & affiliated clinicians

Practitioners 146

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 146

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1316078769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 CENTRAL PKWY E",
            "address_2": "SUITE 275",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "75074",
            "telephone_number": "972-881-4688",
            "fax_number": "972-668-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 CENTRAL PKWY E STE 275",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745542",
            "telephone_number": "972-881-4688",
            "fax_number": "972-668-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHYSIATRY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2017-10-05",
        "deactivation_date": "2013-07-09",
        "reactivation_date": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "LAKSHMAN",
        "authorized_official_first_name": "VENKATESH",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "972-881-4688",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203548702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PALMETTO GBA",
            "identifier": "D07564",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203548701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Physiatry Group LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Plano, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.