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LEGACY DERMATOLOGY PLLC
NPI 1053024554
Dermatology in Algonquin, IL

Active since December 29, 2022CLIA 14D2276062 · Certificate of Compliance
2230 HUNTINGTON DR N, ALGONQUIN, IL 60102(415) 802-1310(847) 960-3675 Get Directions Write a Review

NPPES record last updated: May 22, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 22, 2023, Mar 21, 2023, Dec 29, 2022 (3 updates tracked since 2022).

About Legacy Dermatology Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEGACY DERMATOLOGY PLLC (NPI 1053024554) is a healthcare organization registered as a dermatology in Algonquin, Illinois and active in the NPI registry since December 2022. The organization holds a CLIA Certificate of Compliance certificate valid through January 9, 2027 and lists Laurence Bradley, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1053024554
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLEGACY DERMATOLOGY PLLC
Location Address2230 HUNTINGTON DR NAlgonquin, IL 60102-4419
Mailing Address2230 Huntington Dr NAlgonquin, IL 60102-4419 · (847) 603-4146
Phone(415) 802-1310
Fax(847) 960-3675
Organization SubpartNo
Authorized OfficialLaurence BradleyMd/owner · (415) 802-1310
Enumeration DateDecember 29, 2022
Last NPPES UpdateMay 22, 20233 updates tracked since enumeration
NPPES CertifiedMay 22, 2023
✔ NPI 1053024554 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
2230 HUNTINGTON DR N, Algonquin, IL 60102
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Legacy Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Legacy Dermatology PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Laurence Bradley, M.D.
Dermatology
NPI 1639516313
2230 HUNTINGTON DR N
Algonquin, IL 60102
(847) 603-4146
✔ PECOS✔ Accepts Medicare0.7 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 14D2276062

Legacy Dermatology · Algonquin, IL
Active · expires Jan 9, 2027
CLIA Number14D2276062
Laboratory TypePhysician Office
Certificate Effective DateJanuary 10, 2025
Certificate Expiration DateJanuary 9, 2027
Laboratory DirectorLaurence M. Bradley
Laboratory Phone(847) 603-4146
Laboratory LocationLegacy Dermatology2230 N Huntington Dr, Algonquin, IL 60102
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Legacy Dermatology PLLC's NPI number?

The NPI number for Legacy Dermatology PLLC is 1053024554. It was assigned to this organization in the NPPES registry on December 29, 2022.

Where is Legacy Dermatology PLLC located?

Legacy Dermatology PLLC is located at 2230 Huntington Dr N, Algonquin, IL 60102. The listed phone number is (415) 802-1310.

What is Legacy Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Legacy Dermatology PLLC enrolled in Medicare?

Yes. Legacy Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Legacy Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Legacy Dermatology PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Legacy Dermatology PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 14D2276062) is associated with this NPI, valid through January 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Legacy Dermatology PLLC was last updated on May 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.