Legacy Physiatry

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LEGACY PHYSIATRY

Practice address

126 Verdae Crest Dr
Greenville, SC 29607-3961

Phone

(864) 546-0153

NPI assigned

May 26, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Angelica Maria Soberon-Cassar, MDNPI 1497997761

Title

Owner

Phone

(864) 546-0153

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 2

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.

• Angelica Maria Soberon-Cassar, MD

  • Physical Medicine & Rehabilitation Physician
  • Greenville, SC
  • NPI 1497997761
  Medicare reassignment NPD Authorized official
• Michelle Clayton Benton, NP

  • Nurse Practitioner
  • Simpsonville, SC
  • NPI 1043976160
  Medicare reassignment NPD

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1871168302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 VERDAE CREST DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 VERDAE CREST DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073961",
            "telephone_number": "864-546-0153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY PHYSIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "SOBERON-CASSAR",
        "authorized_official_first_name": "ANGELICA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-546-0153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TBD",
            "affiliation": "N",
            "address_1": "126 Verdae Crest Dr",
            "city": "Greenville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296073961",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sylvester Lee, MD
• Zybre Lee
• Fred Leffert, M.D.
• Legacy Healthcare Services, Inc.
• Legacy Medical Centers, LLC
• Dorterra Leggett
• Tricia Lin Lego, COTA/L
• Edward Lamar Lehman, M.D.
• Rebecca Dawn Leicht, FNP-C
• Leigh Bostic LLC

• Physical Medicine & Rehabilitation Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Physical Medicine & Rehabilitation Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.