PREMIUM LEGACY HEALTHCARE INC
NPI 1184327249
Clinic/Center - Mental Health (Including Community Mental Health Center) in Phoenix, AZ

Q: What is Premium Legacy Healthcare Inc's NPI number?

The NPI number for Premium Legacy Healthcare Inc is 1184327249. It was assigned to this organization in the NPPES registry on March 27, 2023.

Q: What is Premium Legacy Healthcare Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Active since March 27, 2023

5062 N 19TH AVE STE 102, PHOENIX, AZ 85015(773) 319-6420 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 9, 2025, Oct 4, 2024, Mar 27, 2023 (3 updates tracked since 2023).

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About Premium Legacy Healthcare Inc NPPES

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

PREMIUM LEGACY HEALTHCARE INC (NPI 1184327249) is a healthcare organization registered as a mental health (including community mental health center) in Phoenix, Arizona and active in the NPI registry since March 2023. The organization lists Ona Ekhomu, Ceo, as its authorized official.

NPPES Registry Identity

NPI1184327249

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NamePREMIUM LEGACY HEALTHCARE INC

Location Address5062 N 19TH AVE STE 102Phoenix, AZ 85015-3225

Mailing Address11234 N 129th WayScottsdale, AZ 85259-4403 · (773) 319-6420 · Fax (480) 462-5090

Phone(773) 319-6420

Organization SubpartNo

Authorized OfficialOna EkhomuCeo · (773) 319-6420

Enumeration DateMarch 27, 2023

Last NPPES UpdateJuly 9, 20253 updates tracked since enumeration

NPPES CertifiedJuly 9, 2025

✔ NPI 1184327249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

5062 N 19TH AVE STE 102, Phoenix, AZ 85015

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Premium Legacy Healthcare Inc 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 Premium Legacy Healthcare Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Christian Azode, APRN-PMHNP-BC

Nurse Practitioner

NPI 1306492046

1800 E VAN BUREN ST
Phoenix, AZ 85006

(602) 251-8181

✔ PECOS✔ Accepts Medicare5.3 mi

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

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 Premium Legacy Healthcare Inc's NPI number?

The NPI number for Premium Legacy Healthcare Inc is 1184327249. It was assigned to this organization in the NPPES registry on March 27, 2023.

Where is Premium Legacy Healthcare Inc located?

Premium Legacy Healthcare Inc is located at 5062 N 19th Ave Ste 102, Phoenix, AZ 85015. The listed phone number is (773) 319-6420.

What is Premium Legacy Healthcare Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Premium Legacy Healthcare Inc enrolled in Medicare?

Yes. Premium Legacy Healthcare Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Premium Legacy Healthcare Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Premium Legacy Healthcare Inc. 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.

What insurance does Premium Legacy Healthcare Inc accept?

Health plans from Ambetter Health and Ambetter from Arizona Complete Health list Premium Legacy Healthcare Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Premium Legacy Healthcare Inc was last updated on July 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.