LEGACY TREATMENT CENTER LLC
NPI 1336940717
Family Medicine - Addiction Medicine in Fort Wayne, IN
About Legacy Treatment Center Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LEGACY TREATMENT CENTER LLC (NPI 1336940717) is a healthcare organization registered as an addiction medicine in Fort Wayne, Indiana and active in the NPI registry since March 2025. The organization holds a CLIA Waiver certificate valid through August 28, 2027 and lists Abdul Barrie, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted 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)
Legacy Treatment Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Legacy Treatment Center LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
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 15D2329520
Legacy Treatment Center · Fort Wayne, INFrequently 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 Treatment Center LLC's NPI number?
The NPI number for Legacy Treatment Center LLC is 1336940717. It was assigned to this organization in the NPPES registry on March 21, 2025.
Where is Legacy Treatment Center LLC located?
Legacy Treatment Center LLC is located at 3030 Lake Ave Ste 24, Fort Wayne, IN 46805. The listed phone number is (260) 705-4587.
What is Legacy Treatment Center LLC's specialty?
The primary specialty registered for this NPI is Family Medicine, specializing in Addiction Medicine, with taxonomy code 207QA0401X.
Is Legacy Treatment Center LLC enrolled in Medicare?
Yes. Legacy Treatment Center LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Legacy Treatment Center LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Legacy Treatment Center LLC. 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. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Legacy Treatment Center LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 15D2329520) is associated with this NPI, valid through August 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Legacy Treatment Center LLC accept?
Health plans from Anthem Blue Cross and Blue Shield list Legacy Treatment Center LLC 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 Legacy Treatment Center LLC was last updated on December 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# Legacy Treatment Center Llc · NPI 1336940717
Addiction Medicine organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since March 21, 2025.
## Identity
- **NPI:** 1336940717 (Entity type: Organization)
- **Enumerated:** March 21, 2025
- **Primary specialty:** Family Medicine - Addiction Medicine · taxonomy 207QA0401X
- **Organization subpart:** No
- **Authorized official:** Abdul Barrie, CEO
## Practice location
- **Address:** 3030 LAKE AVE STE 24, Fort Wayne, IN 46805-5428
- **Phone:** (260) 705-4587
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 12, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1336940717) · Data from the CMS NPPES public registry.