NPIMap

Organization Active NPI

Legendmed PLLC

  • Certified Registered Nurse Anesthetist
  • Goodyear, AZ
National Provider Identifier
1780359653
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
LEGENDMED PLLC
Practice address
140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226
Phone
(602) 256-2525
NPI assigned
Aug 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Authorized official

Name
Kenneth Jordan Whiting, CRNANPI 1275910523
Title
Owner
Phone
(512) 201-9957

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

140 N Litchfield Rd Ste 110
Goodyear, AZ 85338-1226

Mailing address

PO Box 3394
Idaho Falls, ID 83403-3394
Phone (208) 525-2090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210916000343 AZ Part B Supplier - Clinic/Group Practice 2567869688 Receives reassigned benefits from 3 practitioners
Practice locations: Goodyear, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1780359653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3394",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033394",
            "telephone_number": "208-525-2090",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 N LITCHFIELD RD STE 110",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381226",
            "telephone_number": "602-256-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDMED PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-12",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "WHITING",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-201-9957",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; 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.