Individual provider Active NPI

Jacqueline Jean Legrand, D.O.

  • Pediatrics Physician
  • Lancaster, PA
National Provider Identifier
1740280460
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0S007660L Issued in PA
Practice address
1570 Fruitville Pike
Ste 100
Lancaster, PA 17601-4056
Phone
(717) 569-6481
Fax
(717) 569-5213
NPI assigned
Jul 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0S007660L PA Primary

Addresses

Primary practice location

1570 Fruitville Pike
Ste 100
Lancaster, PA 17601-4056

Mailing address

1570 Fruitville Pike
Ste 100
Lancaster, PA 17601-4056
Phone (717) 569-6481

Other identifiers 1

IdentifierTypeStateIssuer
0015110240001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171031001934 PA Practitioner - Pediatric Medicine 6103128723 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0S007660LPAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lancaster General Medical Group CurrentSince Jul 25, 2022 Accepting new patients
Lancaster General Medical Group CurrentSince Jul 25, 2022 Accepting new patients
Wellspan Medical Group CurrentSince Oct 20, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Oct 20, 2017 Accepting new patients
Lancaster General Medical Group Current Accepting new patients
Wellspan Medical Group Current Accepting new patients
Lancaster General Medical Group Pediatrics Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Lancaster General Medical Group Past Accepting new patients

Locations

1570 Fruitville Pike
Ste 100
Lancaster, PA 17601
Phone (717) 569-6481

3045 Marietta Ave
Lancaster, PA 17601
Phone (717) 299-4644

51 Peters Rd
Ste 202
Lititz, PA 17543
Phone (717) 569-6481

2675 Joppa Rd
York, PA 17403
Phone (717) 741-9063

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

Interoperability endpoints

  • Direct secure messaging: jlegrand225344@direct-lghealth.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1740280460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 FRUITVILLE PIKE",
            "address_2": "STE 100",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014056",
            "telephone_number": "717-569-6481",
            "fax_number": "717-569-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 FRUITVILLE PIKE",
            "address_2": "STE 100",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014056",
            "telephone_number": "717-569-6481",
            "fax_number": "717-569-5213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEGRAND",
        "first_name": "JACQUELINE",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-22",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "0S007660L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015110240001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

Verify at the official NPI Registry.