NPIMap

Organization Active NPI

Legacy Medical Care Inc

  • Federally Qualified Health Center (FQHC)
  • Arlington Heights, IL
National Provider Identifier
1497181697
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEGACY MEDICAL CARE INC
Practice address
3030 W Salt Creek LN Ste 200
Arlington Heights, IL 60005-5002
Phone
(847) 749-2248
Fax
(847) 214-4912
NPI assigned
Sep 19, 2013
Last updated
May 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Authorized official

Name
Melissa D'Onorio
Title
Ceo
Phone
(847) 749-2248

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3030 W Salt Creek LN Ste 200
Arlington Heights, IL 60005-5002

Mailing address

3030 W Salt Creek LN Ste 200
Arlington Heights, IL 60005-5002
Phone (847) 749-2248

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150804004807 IL Part A Provider - Federally Qualified Health Center (FQHC) 7416183298 Practice locations: Arlington Heights, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497181697. Details of each certification follow.

Federally qualified health center certification: CCN 781833

Legal name
LEGACY MEDICAL CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2015
Last certification
Jul 31, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 17, 2013 in IL
Enrollment address
3030 W Salt Creek LN
Ste 200
Arlington Heights, IL 60005-5002

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2026201Legacy Medical Care Inc3030 W Salt Creek Lane, Arlington Heights, IL 60005Provider-performed microscopyJun 26, 2027
14D2067541Legacy Medical Care Inc3030 W Salt Creek Lane, Arlington Heights, IL 60005Certificate of waiverOct 16, 2027

National Provider Directory

National Provider Directory

Locations

3030 W Salt Creek Ln
Ste 200
Arlington Heights, IL 60005
Phone (847) 259-8379

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Klaus Boettcher Individual Corporate OfficerBoard Member Mar 31, 2014
Elise Jimenez Individual Corporate OfficerBoard Meber Mar 31, 2014
Ronald Guild Individual Corporate OfficerBoard Member Mar 31, 2014
Apirata Piyamanond Individual Corporate OfficerBoard Member Mar 31, 2014
Margarita Soto Individual Corporate OfficerBoard Member Mar 31, 2014
Melissa D'Onorio Individual Corporate OfficerCeo Mar 31, 2014 100%
W-2 Managing EmployeeCeo Mar 31, 2014 100%
Operational/Managerial ControlCeo Mar 31, 2014 100%
Martha Cortes Individual Corporate OfficerBoard Member Mar 31, 2014

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778630400000",
    "number": "1497181697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 W SALT CREEK LN STE 200",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600055002",
            "telephone_number": "847-749-2248",
            "fax_number": "847-214-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 W SALT CREEK LN STE 200",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600055002",
            "telephone_number": "847-749-2248",
            "fax_number": "847-214-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY MEDICAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A",
        "authorized_official_last_name": "D'ONORIO",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "847-749-2248"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, IL

Sources for this page

Verify at the official NPI Registry.