| Legacy Physiatry Group Llc | |
|
850 Central Pkwy E Ste 275 Plano TX 75074-5542 | |
| (972) 881-4688 | |
| (972) 668-5401 |
| Full Name | Legacy Physiatry Group Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 850 Central Pkwy E Ste 275, Plano, Texas |
| Authorized Official Name and Position | Venkatesh Lakshman (OWNER/PRESIDENT) |
| Authorized Official Contact | 9728814688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Physiatry Group Llc 850 Central Pkwy E Suite 275 Plano TX 75074 Ph: (972) 881-4688 | Legacy Physiatry Group Llc 850 Central Pkwy E Ste 275 Plano TX 75074-5542 Ph: (972) 881-4688 |
| NPI Number | 1316078769 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 10/05/2017 |
| Medicare PECOS PAC ID | 1759353519 |
|---|---|
| Medicare Enrollment ID | O20070907000584 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316078769 | NPI | - | NPPES |
| 203548702 | Medicaid | TX | |
| 203548701 | Medicaid | TX | |
| D07564 | Other | TX | RAILROAD MEDICARE PALMETTO GBA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Kenneth J Buley |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1497714026 PECOS PAC ID: 8628967197 Enrollment ID: I20040312000528 |
| Provider Name | Thomas C Vinson |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407843287 PECOS PAC ID: 6406748185 Enrollment ID: I20040326001237 |
| Provider Name | Steven R Buck |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1871552059 PECOS PAC ID: 3870585052 Enrollment ID: I20040330001133 |
| Provider Name | Elia G Keck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215904081 PECOS PAC ID: 3274520770 Enrollment ID: I20040427001263 |
| Provider Name | Melissa C. Lockhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376620096 PECOS PAC ID: 6002804481 Enrollment ID: I20040504001067 |
| Provider Name | Pedro T Zevallos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891729091 PECOS PAC ID: 6901882075 Enrollment ID: I20050223000911 |
| Provider Name | Victor Madrigal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629295480 PECOS PAC ID: 2163438912 Enrollment ID: I20060302000478 |
| Provider Name | Dorothy D Goddard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669562724 PECOS PAC ID: 2769589472 Enrollment ID: I20070515000057 |
| Provider Name | Jennifer J Schmoker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205819612 PECOS PAC ID: 4981778479 Enrollment ID: I20080731000658 |
| Provider Name | Kathleen M Oneill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306942263 PECOS PAC ID: 6608938980 Enrollment ID: I20081219000546 |
| Provider Name | Shalini Katikaneni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326221649 PECOS PAC ID: 6608938840 Enrollment ID: I20081222000345 |
| Provider Name | Fonshay Latrice Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588814263 PECOS PAC ID: 0840354833 Enrollment ID: I20090206000188 |
| Provider Name | Bobbie J Simlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922296003 PECOS PAC ID: 2264598507 Enrollment ID: I20090311000455 |
| Provider Name | Mohamed H Youssef |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1033446687 PECOS PAC ID: 6305987041 Enrollment ID: I20100104000345 |
| Provider Name | Rebecca S Schmidt |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1538114087 PECOS PAC ID: 1153514989 Enrollment ID: I20101025000629 |
| Provider Name | Dusty R Wilkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396045506 PECOS PAC ID: 4486837044 Enrollment ID: I20110321000403 |
| Provider Name | Eric Isaac Ray |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1598965428 PECOS PAC ID: 2365625191 Enrollment ID: I20110331000483 |
| Provider Name | Brenda Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285930354 PECOS PAC ID: 5395929343 Enrollment ID: I20110415000212 |
| Provider Name | Jacqueline C. Mosley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215233242 PECOS PAC ID: 3577747559 Enrollment ID: I20110415000595 |
| Provider Name | Victor H Flores |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1760454565 PECOS PAC ID: 3678579901 Enrollment ID: I20110705000251 |
| Provider Name | Cristina L Winters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942527056 PECOS PAC ID: 3274797550 Enrollment ID: I20120627000631 |
| Provider Name | Veronica Cardenas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689957599 PECOS PAC ID: 8426214792 Enrollment ID: I20120801000225 |
| Provider Name | Nisha Jain |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1881875862 PECOS PAC ID: 7214841006 Enrollment ID: I20130213000367 |
| Provider Name | Eunice Orji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811248891 PECOS PAC ID: 6406001106 Enrollment ID: I20130312000038 |
| Provider Name | Avram Aaron Bram-mostyn |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1295094845 PECOS PAC ID: 5496993453 Enrollment ID: I20130603000463 |
| Provider Name | Peace Uwaeme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558612325 PECOS PAC ID: 1254567704 Enrollment ID: I20140109000153 |
| Provider Name | Elizabeth A Seegers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689000887 PECOS PAC ID: 8325271448 Enrollment ID: I20140425000674 |
| Provider Name | Jilji Payikkattu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275950453 PECOS PAC ID: 5092039594 Enrollment ID: I20150109000701 |
| Provider Name | Kathleen Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316256746 PECOS PAC ID: 0446576391 Enrollment ID: I20150311002355 |
| Provider Name | Toyin Kehinde Aliu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497145965 PECOS PAC ID: 2668784018 Enrollment ID: I20150629000488 |
| Provider Name | Corrie V. Kolev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881090173 PECOS PAC ID: 0244532059 Enrollment ID: I20160112000352 |
| Provider Name | Gwendoline K Mbaku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447624853 PECOS PAC ID: 0345544037 Enrollment ID: I20160201000036 |
| Provider Name | Neena Papneja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104170349 PECOS PAC ID: 0749592855 Enrollment ID: I20160216001041 |
| Provider Name | Stella Apari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023476934 PECOS PAC ID: 7113078809 Enrollment ID: I20160316001787 |
| Provider Name | Lamese Ann Sabri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730575374 PECOS PAC ID: 8820318165 Enrollment ID: I20160706001793 |
| Provider Name | Asongtia Ntonghawah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811343338 PECOS PAC ID: 6901198027 Enrollment ID: I20160711002352 |
| Provider Name | Ajai Sambasivan |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1992090955 PECOS PAC ID: 9133414378 Enrollment ID: I20160826000472 |
| Provider Name | Uju Anyanwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720531130 PECOS PAC ID: 3375831837 Enrollment ID: I20161017000475 |
| Provider Name | Martha Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083716450 PECOS PAC ID: 5092882159 Enrollment ID: I20161115000086 |
| Provider Name | Maureen Evelyn Joyner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265980247 PECOS PAC ID: 7810277399 Enrollment ID: I20161130000828 |
| Provider Name | Monica Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184077091 PECOS PAC ID: 1052691276 Enrollment ID: I20161206000488 |
| Provider Name | Josephine Mandeya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609226505 PECOS PAC ID: 7113205089 Enrollment ID: I20170525000128 |
| Provider Name | Christina Paruthi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1598070799 PECOS PAC ID: 1153699988 Enrollment ID: I20170619002396 |
| Provider Name | Tinuola Oyeku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861937146 PECOS PAC ID: 1355611419 Enrollment ID: I20170721001801 |
| Provider Name | Prisca Ughanze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427400571 PECOS PAC ID: 6901178573 Enrollment ID: I20170816002366 |
| Provider Name | Irene O Oyolu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184166290 PECOS PAC ID: 4385917806 Enrollment ID: I20170906000233 |
| Provider Name | Carlos A Jaramillo |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1982863056 PECOS PAC ID: 9739313347 Enrollment ID: I20170922002668 |
| Provider Name | Lakenya Chimere Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437559408 PECOS PAC ID: 4183844590 Enrollment ID: I20171004000955 |
| Provider Name | Shantell K Hayes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710499686 PECOS PAC ID: 4284992926 Enrollment ID: I20171229000715 |
| Provider Name | Cristal N Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730571357 PECOS PAC ID: 3577823863 Enrollment ID: I20180206000784 |
| Provider Name | Ugochi Odinmah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326574195 PECOS PAC ID: 9133480775 Enrollment ID: I20180222002762 |
| Provider Name | Ashley Hunt Falkner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356781538 PECOS PAC ID: 8123259892 Enrollment ID: I20180420001930 |
| Provider Name | Brittany Bickelhaupt |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1477948834 PECOS PAC ID: 7113226648 Enrollment ID: I20180521002634 |
| Provider Name | Mark Bauernfeind |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1467870436 PECOS PAC ID: 4587958947 Enrollment ID: I20180604000966 |
| Provider Name | Nkechinyere C Anyikwa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952886624 PECOS PAC ID: 9436401668 Enrollment ID: I20181016002101 |
| Provider Name | Redemptor K Omariba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831677616 PECOS PAC ID: 7214271204 Enrollment ID: I20181203000421 |
| Provider Name | Stefanie Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811460330 PECOS PAC ID: 0143569988 Enrollment ID: I20190222000777 |
| Provider Name | Laurie J Pung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528049970 PECOS PAC ID: 6002885399 Enrollment ID: I20190723002499 |
| Provider Name | Seema R Sebastian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497286199 PECOS PAC ID: 3971877309 Enrollment ID: I20191210002803 |
| Provider Name | Vincent Pierce Torrefranca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033745153 PECOS PAC ID: 9234568973 Enrollment ID: I20200401001973 |
| Provider Name | Samuel Mboya Ouya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427677913 PECOS PAC ID: 7719317338 Enrollment ID: I20200423000386 |
| Provider Name | John David Arcure |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1770713711 PECOS PAC ID: 1557510088 Enrollment ID: I20200504001422 |
| Provider Name | Anthony Okechukwu Ezemba |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1336546084 PECOS PAC ID: 3274882774 Enrollment ID: I20210716002746 |
| Provider Name | Rebecca H Odidi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790328664 PECOS PAC ID: 8224422159 Enrollment ID: I20220218001121 |
| Provider Name | Melissa Godfrey Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467060889 PECOS PAC ID: 8820483514 Enrollment ID: I20220316000182 |
| Provider Name | Nehalben Sachin Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720687064 PECOS PAC ID: 9739567264 Enrollment ID: I20220611000091 |
| Provider Name | Keara Eunice Gary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932878626 PECOS PAC ID: 5890175061 Enrollment ID: I20220706000377 |
| Provider Name | Seth M Probert |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1326500851 PECOS PAC ID: 0244609873 Enrollment ID: I20221202002987 |
| Provider Name | Karen K Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144672478 PECOS PAC ID: 3375821085 Enrollment ID: I20230119003178 |
| Provider Name | Gabrielle Estelle Beyidi Noah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245944305 PECOS PAC ID: 0749652253 Enrollment ID: I20230209002432 |
| Provider Name | Aaron Michael Prado |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1922568815 PECOS PAC ID: 6507191715 Enrollment ID: I20230515001014 |
| Provider Name | Adelwisa Ave |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891336020 PECOS PAC ID: 8729418223 Enrollment ID: I20240212004142 |
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