NPIMap

Organization Active NPI

Legacy Health Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Largo, FL
National Provider Identifier
1881942779
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
LEGACY HEALTH MEDICAL GROUP, LLC
Practice address
801 W Bay Dr Ste 605
Largo, FL 33770-3268
Phone
(727) 489-3305
Fax
(727) 499-9559
NPI assigned
Aug 27, 2012
Last updated
Sep 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

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

Authorized official

Name
Dr. Sunit Srivastava, M.D.NPI 1881889467
Title
Managing Member
Phone
(727) 644-1540

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Gerontology Nurse Practitioner 363LG0600X NU
Wound Care Registered Nurse 163WW0000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
General Practice Physician 208D00000X ME105069 FL

Addresses

Primary practice location

801 W Bay Dr Ste 605
Largo, FL 33770-3268

Mailing address

801 W Bay Dr Ste 605
Largo, FL 33770-3268
Phone (727) 489-3305

Other identifiers 1

IdentifierTypeStateIssuer
ME105069OtherFLMEDICAL LICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130510000372 FL Part B Supplier - Clinic/Group Practice 5193962173 Receives reassigned benefits from 19 practitioners
Practice locations: Clearwater, FL; Largo, FL; Seminole, FL

National Provider Directory

National Provider Directory

Locations

3500 Oak Manor Ln
#46
Largo, FL 33774

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1881942779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W BAY DR STE 605",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703268",
            "telephone_number": "727-489-3305",
            "fax_number": "727-499-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W BAY DR STE 605",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337703268",
            "telephone_number": "727-489-3305",
            "fax_number": "727-499-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "SRIVASTAVA",
        "authorized_official_first_name": "SUNIT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "727-644-1540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME105069",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "ME105069",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

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