Bellevue Legacy Primary Care PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BELLEVUE LEGACY PRIMARY CARE PLLC

Practice address

2820 Northup Way Ste 200
Bellevue, WA 98004-1498

Phone

(425) 484-4050

Fax

(425) 488-4050

NPI assigned

Jun 26, 2024

Organization subpart

No

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

Authorized official

Name

Devin Schock, MDNPI 1649617382

Title

Physician

Phone

(425) 484-4050

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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.

• Devin P Schock, MD

  • Family Medicine Physician
  • Bellevue, WA
  • NPI 1649617382
  Medicare reassignment Care Compare group NPD Authorized official
• Jenna Lynn Donnerberg, MSN, APRN-BC

  • Family Nurse Practitioner
  • Monroe, WA
  • NPI 1952132359
  Medicare reassignment Care Compare group NPD
• David S Goodman, MD

  • Pain Medicine (Anesthesiology) Physician
  • Bellevue, WA
  • NPI 1770588113
  NPD

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1619712320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 NORTHUP WAY STE 200",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041498",
            "telephone_number": "425-484-4050",
            "fax_number": "425-488-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 NORTHUP WAY STE 200",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041498",
            "telephone_number": "425-484-4050",
            "fax_number": "425-488-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE LEGACY PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "SCHOCK",
        "authorized_official_first_name": "DEVIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "425-484-4050",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bellevue Internal Medicine Associates PLLC
• Bellevue Interventional Spine Specialist PS (Bellevue Spine Specialist)
• Bellevue Interventional Spine Specialist PS (Bellevue Spine Specialist)
• Bellevue Kidney Specialists PLLC
• Bellevue Laser and Cosmetic Center PS
• Bellevue Medical Center
• Bellevue Medical Imaging, PLLC
• Bellevue Neurology and Neuroscience PLLC
• Bellevue Neuromuscular Dentistry LLC
• Bellevue OBGYN LLC

• Family Medicine Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.