NPIMap

Organization Active NPI

Legacy Physician Group, P.C.

  • Specialist
  • Lansing, MI
National Provider Identifier
1801800719
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LEGACY PHYSICIAN GROUP, P.C.
Practice address
1540 Lake Lansing Rd
102
Lansing, MI 48912-3756
Phone
(517) 913-3900
NPI assigned
Jul 28, 2006
Last updated
Feb 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Authorized official

Name
Susan Therese Fedewa, DRNPI 1750336004
Title
President
Phone
(517) 913-6711

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
Specialist 174400000X NU Primary

Addresses

Primary practice location

1540 Lake Lansing Rd
102
Lansing, MI 48912-3756

Mailing address

1540 Lake Lansing Rd Ste 203
Lansing, MI 48912-3757
Phone (517) 913-6711

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061101000048 MI Part B Supplier - Clinic/Group Practice 0648277830 Receives reassigned benefits from 17 practitioners
Practice locations: Lansing, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1801800719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 LAKE LANSING RD STE 203",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489123757",
            "telephone_number": "517-913-6711",
            "fax_number": "517-913-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 LAKE LANSING RD",
            "address_2": "102",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489123756",
            "telephone_number": "517-913-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHYSICIAN GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-05",
        "status": "A",
        "authorized_official_last_name": "FEDEWA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "THERESE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "517-913-6711",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.