HEATHER KAY LEGG PA-C
NPI 1154844249
Physician Assistant in Madison, WV

NPI Status: Active since July 20, 2017

Contact Information

701 MADISON AVE
MADISON, WV
ZIP 25130
Phone: (304) 369-1230

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Medicare Participation & PECOS Status
Areas of Expertise
Durable Medical Equipment
Physician Visit Costs
Hospital Affiliations - Privileges
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Years of Experience 9
Physician Assistant
Accepts Insurance
Accepts Medicare Approved Payment
PECOS Enrolled

About HEATHER LEGG

This page provides the complete NPI Profile along with additional information for Heather Legg, a primary care provider established in Madison, West Virginia with a medical specialization in Physician Assistant and more than 9 years of experience. The healthcare provider is registered in the NPI registry with number 1154844249 assigned on July 2017. The practitioner's primary taxonomy code is 363A00000X with license number 2075 (WV). The provider is registered as an individual and her NPI record was last updated 9 years ago.

NPI: 1154844249
Provider Name: HEATHER KAY LEGG PA-C
Gender: Female
Entity Type: Individual
Location Address: 701 MADISON AVE MADISON, WV 25130
Location Phone: (304) 369-1230
Mailing Address: 700 LIME KILN RD RED HOUSE, WV 25168
Mailing Phone: (304) 543-7241
Medical School Name: OTHER
Graduation Year: 2017
Is Sole Proprietor?: No
Enumeration Date: 07-20-2017
Last Update Date: 07-20-2017
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A primary care provider (PCP) like Heather Legg sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Physician Assistant
Taxonomy Code: 363A00000X
Type: Physician Assistants & Advanced Practice Nursing Providers
License No.: 2075
License State: WV
Taxonomy Description: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Highmark Blue Cross Blue Shield West Virginia

my Blue Access WV Major Events PPO Catastrophic 10600 - 3 Free PCP Visits - PPO
my Blue Access WV PPO Bronze 3800 - PPO
my Blue Access WV PPO Bronze 3800 + Adult Dental and Vision - PPO
my Blue Access WV PPO Bronze 9200 - PPO
my Blue Access WV PPO Gold 0 - PPO
my Blue Access WV PPO Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Gold 1700 HSA - PPO
my Blue Access WV PPO Premier Gold 0 - PPO
my Blue Access WV PPO Premier Gold 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Premier Silver 0 - PPO
my Blue Access WV PPO Premier Silver 0 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Bronze 7500 - PPO
my Blue Access WV PPO Standard Gold 2000 - PPO
my Blue Access WV PPO Standard Gold 2000 + Adult Dental and Vision - PPO
my Blue Access WV PPO Standard Silver 6000 - PPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Medicare Participation & PECOS Enrollment Status

Heather Legg is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Heather Legg is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

Is the provider registered in PECOS? Yes
PECOS PAC ID: 6406112945
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.
PECOS Enrollment ID: I20171115003751
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.
Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

DME-Oxygen and Supplies (DC000N)
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)
1 DME suppliers used 12 Medicare Claims 12 Services Paid
DME-Oxygen and Supplies (DC002N)
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)
1 DME suppliers used 12 Medicare Claims 12 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Emergency department visit for life threatening or functioning severity
Emergency department visit for problem of high severity
Hospital observation care on day of discharge
Initial hospital observation care per day, typically 30 minutes
Initial hospital observation care per day, typically 70 minutes
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $20.87 for a new patient copayment and $16.71 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 25130 ZIP code area.

New Patients Visit Costs *

The most utilized procedure code for new patients office visits is 99203

Average New Patient Price $83.49
Minimum New Patient Price $53.2
Maximum New Patient Price $164.59

Average New Patient Copayment $20.87
Minimum New Patient Copayment $13.3
Maximum New Patient Copayment $41.14

Established Patients Visit Costs *

The most utilized procedure code for established patients office visits is 99213

Average Established Patient Price $66.84
Minimum Established Patient Price $16.47
Maximum Established Patient Price $133.29

Average Established Patient Copayment $16.71
Minimum Established Patient Copayment $4.11
Maximum Established Patient Copayment $33.32

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Heather Legg is affiliated with the following medical facilities:

Hospital Name	Address	Phone	Hospital Type	Overall Rating
ST MARY'S MEDICAL CENTER	2900 1ST AVENUE HUNTINGTON, WV 25702	(304) 526-1234	Acute Care Hospitals

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1154844249, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 10 → 1 + 0

Pos 4

Unchanged

Pos 5

Doubled → 16 → 1 + 6

Pos 6

Unchanged

Pos 7

Doubled → 8

Pos 8

Unchanged

Pos 9

Doubled → 8

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 5 → 10 → 1 8 → 16 → 7 4 → 8 4 → 8

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 1 + 0 + 4 + 1 + 6 + 4 + 8 + 2 + 8 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9

This NPI is valid

The calculated check digit is 9, which matches the last digit of 1154844249.