Legacy Care Aco Llc | |
2901 S Lynnhaven Rd Ste 450 Virginia Bch VA 23452-8524 | |
(757) 536-2411 | |
Not Available |
Full Name | Legacy Care Aco Llc |
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Speciality | Family Medicine |
Location | 2901 S Lynnhaven Rd Ste 450, Virginia Bch, Virginia |
Authorized Official Name and Position | Traci Lopez (DIRECTOR REVENUE CYCLE) |
Authorized Official Contact | 7575362411 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Legacy Care Aco Llc 2901 S Lynnhaven Rd Ste 450 Virginia Bch VA 23452-8524 Ph: (757) 536-2411 | Legacy Care Aco Llc 2901 S Lynnhaven Rd Ste 450 Virginia Bch VA 23452-8524 Ph: (757) 536-2411 |
NPI Number | 1538844857 |
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Provider Enumeration Date | 06/15/2023 |
Last Update Date | 07/06/2023 |
Medicare PECOS PAC ID | 3274996426 |
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Medicare Enrollment ID | O20230906000290 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538844857 | NPI | - | NPPES |
Provider Name | Amjad Mughal |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1790862746 PECOS PAC ID: 0244227981 Enrollment ID: I20040426001925 |
Provider Name | Rex D Biedenbender |
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Provider Type | Practitioner - Geriatric Medicine |
Provider Identifiers | NPI Number: 1184696148 PECOS PAC ID: 4880660620 Enrollment ID: I20040902001460 |
Provider Name | Gerard Abate |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1669565636 PECOS PAC ID: 4981664596 Enrollment ID: I20041018000365 |
Provider Name | Aparna Ranjan |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336171792 PECOS PAC ID: 4981617222 Enrollment ID: I20060803000131 |
Provider Name | Maria Doubrovskaia |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1760601306 PECOS PAC ID: 9830285592 Enrollment ID: I20071011000412 |
Provider Name | Francis M Taylor |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336222157 PECOS PAC ID: 0648233395 Enrollment ID: I20071101000171 |
Provider Name | Jesus A Martinez |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1588616908 PECOS PAC ID: 8224924964 Enrollment ID: I20071213000272 |
Provider Name | Danny W Felty |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1730164971 PECOS PAC ID: 8729163522 Enrollment ID: I20080304000295 |
Provider Name | Vanessa Peyton Fowlkes |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467477273 PECOS PAC ID: 6800970047 Enrollment ID: I20090928000690 |
Provider Name | Cynthia Blain Bettinger |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1548239916 PECOS PAC ID: 8527108125 Enrollment ID: I20091211000451 |
Provider Name | Coleen P Kenny |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811071905 PECOS PAC ID: 9335283613 Enrollment ID: I20100224000866 |
Provider Name | Thelma Jane Pealer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326370362 PECOS PAC ID: 9234253790 Enrollment ID: I20100907000092 |
Provider Name | Edwina C Wilson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1053313957 PECOS PAC ID: 3274502760 Enrollment ID: I20101022000736 |
Provider Name | Pauravi Harkisandas Sanghadia |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1609946201 PECOS PAC ID: 0446357214 Enrollment ID: I20110804000511 |
Provider Name | Mark J Hippenstiel |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265497838 PECOS PAC ID: 6103919139 Enrollment ID: I20111206000625 |
Provider Name | Kathleen Marie Anderson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104157650 PECOS PAC ID: 3375700446 Enrollment ID: I20120201000021 |
Provider Name | Patricia L Schmitz |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1578668398 PECOS PAC ID: 9739134966 Enrollment ID: I20120206000029 |
Provider Name | Ruby M Ford |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831467489 PECOS PAC ID: 9830359769 Enrollment ID: I20120329000561 |
Provider Name | Melissa L Stanley |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083988778 PECOS PAC ID: 4587825898 Enrollment ID: I20120413000153 |
Provider Name | James David Danner |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407072069 PECOS PAC ID: 5092963165 Enrollment ID: I20120914000001 |
Provider Name | Heather Dawn Mullen |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124356290 PECOS PAC ID: 6204072135 Enrollment ID: I20130617000063 |
Provider Name | Cathy A Jones |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881033199 PECOS PAC ID: 3072756493 Enrollment ID: I20130903000627 |
Provider Name | Candice Shirlen Hughes |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376864496 PECOS PAC ID: 8022255991 Enrollment ID: I20131015000027 |
Provider Name | Jared D March |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1073834156 PECOS PAC ID: 4789831595 Enrollment ID: I20131030001895 |
Provider Name | Fei Han |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669837118 PECOS PAC ID: 1850694423 Enrollment ID: I20160115000024 |
Provider Name | Kedest Gebreselassie |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1265897391 PECOS PAC ID: 0941503932 Enrollment ID: I20160126000557 |
Provider Name | Darshana Chadda |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1194920140 PECOS PAC ID: 1456496850 Enrollment ID: I20160610000695 |
Provider Name | Donna S Meade |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619339975 PECOS PAC ID: 3779873237 Enrollment ID: I20160613000779 |
Provider Name | Jaimie Tahir |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528420544 PECOS PAC ID: 7719270503 Enrollment ID: I20160802000549 |
Provider Name | Julie A Miller |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811446412 PECOS PAC ID: 5799065496 Enrollment ID: I20161215002066 |
Provider Name | Edwan T Kibot |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508213398 PECOS PAC ID: 6608159363 Enrollment ID: I20170203001785 |
Provider Name | Darniesha Greene |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710427653 PECOS PAC ID: 4789961350 Enrollment ID: I20170509000537 |
Provider Name | Gina L Collins |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033655741 PECOS PAC ID: 2163798307 Enrollment ID: I20171016003187 |
Provider Name | Steffanie A Epstein |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033628185 PECOS PAC ID: 7911265426 Enrollment ID: I20171211000345 |
Provider Name | Jacqueline Kelly |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1124109624 PECOS PAC ID: 8123393956 Enrollment ID: I20180104000585 |
Provider Name | Jennifer Latasha Fields |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447765573 PECOS PAC ID: 6800150004 Enrollment ID: I20180515001687 |
Provider Name | Chassitie Gomez |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720574726 PECOS PAC ID: 1153671011 Enrollment ID: I20180913003435 |
Provider Name | Abigail Amuquandoh |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669951869 PECOS PAC ID: 6800140153 Enrollment ID: I20181126003273 |
Provider Name | Tilahun Goshu |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336628551 PECOS PAC ID: 2567700107 Enrollment ID: I20190206002779 |
Provider Name | Alysha Nicole Bugg |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619435534 PECOS PAC ID: 4284977174 Enrollment ID: I20190516000711 |
Provider Name | Joanne Emilia Sproule |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528551728 PECOS PAC ID: 4880928886 Enrollment ID: I20190625003075 |
Provider Name | Amanda R Welch |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134627169 PECOS PAC ID: 3779828421 Enrollment ID: I20190917003780 |
Provider Name | Jennifer Nicole Clarke |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134756802 PECOS PAC ID: 1850722596 Enrollment ID: I20200512002902 |
Provider Name | Takara Joy Figueroa |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366962052 PECOS PAC ID: 1355766353 Enrollment ID: I20200807002494 |
Provider Name | Katina Knight |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023628534 PECOS PAC ID: 2668884040 Enrollment ID: I20201208002179 |
Provider Name | Margarita Maria Marmolejo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760035810 PECOS PAC ID: 9032524764 Enrollment ID: I20210210002252 |
Provider Name | Michelle Lazarus |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336782788 PECOS PAC ID: 6507294436 Enrollment ID: I20210212000186 |
Provider Name | Kenjilyn Uchida Ares |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932708971 PECOS PAC ID: 8820403025 Enrollment ID: I20210222001547 |
Provider Name | Jill Bates Jones |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942892625 PECOS PAC ID: 3971911769 Enrollment ID: I20210415001502 |
Provider Name | Doris T Mbony |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528326337 PECOS PAC ID: 9032539267 Enrollment ID: I20210714000816 |
Provider Name | Marquail Mcbride |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659943843 PECOS PAC ID: 3375933773 Enrollment ID: I20211129000724 |
Provider Name | Haise S Reardon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851065684 PECOS PAC ID: 1557756210 Enrollment ID: I20220315002146 |
Provider Name | Jessica Deal |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205204583 PECOS PAC ID: 9335458157 Enrollment ID: I20220323002887 |
Provider Name | Ashley Hendrix |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376743781 PECOS PAC ID: 4789862608 Enrollment ID: I20220324001941 |
Provider Name | Stacie Pittman |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144899592 PECOS PAC ID: 3870980758 Enrollment ID: I20220422001695 |
Provider Name | David Toshio Eki |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215438221 PECOS PAC ID: 7517354145 Enrollment ID: I20220504002163 |
Provider Name | Joseph Maurice Hicks |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1255074993 PECOS PAC ID: 1557749439 Enrollment ID: I20220606000735 |
Provider Name | Yunique Carrington Wilson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598406746 PECOS PAC ID: 0042691685 Enrollment ID: I20220713004390 |
Provider Name | Iris Nagin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043398340 PECOS PAC ID: 0941377725 Enrollment ID: I20220818000437 |
Provider Name | Arnel Agravante Lacerna |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1912636481 PECOS PAC ID: 9830565464 Enrollment ID: I20221021001658 |
Provider Name | Melanie R De Jesus |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346978475 PECOS PAC ID: 4183093974 Enrollment ID: I20221219001025 |
Provider Name | Angela Harris-bonner |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134566334 PECOS PAC ID: 6002281797 Enrollment ID: I20230411002217 |
Provider Name | Olatunde Akinfolajimi |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295423887 PECOS PAC ID: 7719346733 Enrollment ID: I20230707002761 |
Provider Name | Tracey A Yeboah |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902430986 PECOS PAC ID: 8527420561 Enrollment ID: I20230808003228 |
Provider Name | Amma Boafo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780373308 PECOS PAC ID: 1254791338 Enrollment ID: I20230815002797 |
Provider Name | Monica Latoya Alade |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1396520318 PECOS PAC ID: 7214382829 Enrollment ID: I20231017000183 |
Provider Name | Manju T Jose |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023885373 PECOS PAC ID: 5698125029 Enrollment ID: I20240109000113 |
Provider Name | Abdul Kawa |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891566444 PECOS PAC ID: 9537505698 Enrollment ID: I20240311004021 |
Provider Name | Shannon Denise Brackett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639946643 PECOS PAC ID: 7214374941 Enrollment ID: I20240318001865 |
Provider Name | Michon Blowe |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083091656 PECOS PAC ID: 6204165590 Enrollment ID: I20240322002018 |
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