Timothy Legg
Individual provider Active NPI Medical Physician Assistant · Laverne, OK
NPI 1417598293 · NPPES record last updated Dec 22, 2020
Key facts
- NPI
- 1417598293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 3169 (OK)
- Practice address
- 7TH & Oklahoma Ste 5
Laverne, OK 73848-0987 - Phone
- (580) 921-3355
- NPI assigned
- Oct 3, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- The Physicians Group, LLC
Practice addresses (Care Compare)
10021 S Western Ave
Oklahoma City, OK 73139-2927
Phone (405) 692-9300
1616 S Kelly Ave
Edmond, OK 73013-3651
Phone (405) 330-0032
3115 SW 89TH St
Oklahoma City, OK 73159-7901
Phone (405) 486-6860
Hospital & facility affiliations
- Community Hospital, LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200319002732 | OK | Practitioner - Physician Assistant | 2466880745 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3169 | OK | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harper County Community Hospital | Past | Accepting new patients |
Interoperability endpoints
- tlegg521647@direct.integrisok.com
- tlegg350966@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3169 | OK | Yes |
Addresses
Primary practice location
7TH & Oklahoma Ste 5
Laverne, OK 73848-0987
Mailing address
PO Box 336
Buffalo, OK 73834-0336
Phone (520) 780-3920
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200892080A | Medicaid | OK |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tlegg350966@direct-ehr-ssmhc.com | Direct |
Other providers in Laverne, OK
- Gregory Scott Huenergardt
- Laverne Ambulance Service
- Laverne Pharmacy Management Inc
- Laverne Pharmacy Management Inc
- Laverne Public Schools
- Shelley K Noble
- Northwest Center for Behavioral Health
- Karla Paola Pacheco Salazar
- Jennifer Rose Penquite
- Western Plains Youth & Family Services, Inc.
All providers in Laverne, OK · Medical Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.