Legacy Primary Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LEGACY PRIMARY CARE

Practice address

11990 Grant St Ste 110
Northglenn, CO 80233-1122

Phone

(720) 928-0244

Fax

(720) 928-0247

NPI assigned

Mar 18, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Deric J Rachjaibun, MDNPI 1902903933

Title

Owner

Phone

(720) 928-0244

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

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

• Deric J Rachjaibun, MD

  • Family Medicine Physician
  • Northglenn, CO
  • NPI 1902903933
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1841090735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11990 GRANT ST STE 110",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331122",
            "telephone_number": "720-928-0244",
            "fax_number": "720-928-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 GRANT ST STE 110",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331122",
            "telephone_number": "720-928-0244",
            "fax_number": "720-928-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "RACHJAIBUN",
        "authorized_official_first_name": "DERIC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-928-0244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenny Le, LPC
• Holly Leach
• Gabriel Ledezma
• Rebecca Lee
• Sabrina Leenerts
• Heili Dawn Lehr, LPC
• Katherine Elizabeth Leiter, OT
• Kelly Leonard
• Dezarae Leone
• Cari Elizabeth Lewis

• Primary Care Clinic/Center in Northglenn, CO
• Providers in Northglenn, CO by specialty
• Primary Care Clinic/Center in Colorado

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