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307 LONGEVITY PC
NPI 1316783673
Clinic/Center in Cody, WY

Active since July 06, 2024CLIA 53D2313176 · Waiver
1120 BECK AVE, CODY, WY 82414(307) 527-0355(307) 527-0360 Get Directions Write a Review

NPPES record last updated: July 6, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About 307 Longevity Pc NPPES

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

307 LONGEVITY PC (NPI 1316783673), doing business as The Legacy Clinic, is a healthcare organization registered as a clinic/center in Cody, Wyoming and active in the NPI registry since July 2024. The organization holds a CLIA Waiver certificate valid through October 24, 2026 and lists Christopher Thoma, Owner, as its authorized official.

NPPES Registry Identity

NPI1316783673
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business Name307 LONGEVITY PC
Location Address1120 BECK AVECody, WY 82414-3624
Mailing AddressPo Box 308Wapiti, WY 82450-0308 · (307) 899-0009
Phone(307) 527-0355
Fax(307) 527-0360
Organization SubpartNo
Authorized OfficialChristopher ThomaOwner · (307) 899-0009
Enumeration DateJuly 6, 2024
NPPES CertifiedJuly 6, 2024
✔ NPI 1316783673 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
1120 BECK AVE, Cody, WY 82414
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Other Names 1

Doing Business AsThe Legacy Clinic

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

307 Longevity Pc 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 307 Longevity PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Christopher Thoma, D.C.
Chiropractic
NPI 1679942775
1120 BECK AVE
Cody, WY 82414
(307) 527-0355
Same address

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 Waiver 53D2313176

307 Longevity Dba The Legacy Clinic · Cody, WY
Active · expires Oct 24, 2026
CLIA Number53D2313176
Laboratory TypePhysician Office
Certificate Effective DateOctober 25, 2024
Certificate Expiration DateOctober 24, 2026
Laboratory DirectorThoma F. Christopher
Laboratory Phone(307) 527-0355
Laboratory Location307 Longevity Dba The Legacy Clinic1120 Beck Ave, Cody, WY 82414
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 307 Longevity PC's NPI number?

The NPI number for 307 Longevity PC is 1316783673. It was assigned to this organization in the NPPES registry on July 6, 2024. The provider is doing business as The Legacy Clinic.

Where is 307 Longevity PC located?

307 Longevity PC is located at 1120 Beck Ave, Cody, WY 82414. The listed phone number is (307) 527-0355.

What is 307 Longevity PC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is 307 Longevity PC enrolled in Medicare?

Yes. 307 Longevity PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through 307 Longevity PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to 307 Longevity PC. 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 307 Longevity PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 53D2313176) is associated with this NPI, valid through October 24, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for 307 Longevity PC was last updated on July 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.