NPIMap

Organization Active NPI

Legacy Physiatry Group Maryland, LLC

Doing business as Legacy Physiatry Group

  • Physical Medicine & Rehabilitation Physician
  • Gaithersburg, MD
National Provider Identifier
1669869939
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
LEGACY PHYSIATRY GROUP MARYLAND, LLC
Doing business as
Legacy Physiatry Group
Practice address
9711 Washingtonian Blvd Ste 550
Gaithersburg, MD 20878-5789
Phone
(972) 881-4688
Fax
(972) 372-1657
NPI assigned
Apr 23, 2015
Last updated
Oct 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Authorized official

Name
Marilyn J Mearon
Title
Billing Manager
Phone
(972) 881-4688

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Internal Medicine Physician 207R00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

9711 Washingtonian Blvd Ste 550
Gaithersburg, MD 20878-5789

Mailing address

850 Central Pkwy E Ste 275
Plano, TX 75074-5542
Phone (972) 881-4688

Other names 1

  • Legacy Physiatry Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150619000722 MD Part B Supplier - Clinic/Group Practice 1355652108 Receives reassigned benefits from 6 practitioners
Practice locations: Columbia, MD
O20230922002696 DC Part B Supplier - Clinic/Group Practice 1355652108 Receives reassigned benefits from 2 practitioners
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory

Locations

850 Central Pkwy E
Plano, TX 75074

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": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1669869939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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": "972-372-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9711 WASHINGTONIAN BLVD STE 550",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208785789",
            "telephone_number": "972-881-4688",
            "fax_number": "972-372-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHYSIATRY GROUP MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "MEARON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "972-881-4688"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Physiatry Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Legacy Physiatry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.