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BELLEVUE LEGACY PRIMARY CARE PLLC
NPI 1619712320
Family Medicine in Bellevue, WA

Active since June 26, 2024CLIA 50D2313264 · Waiver
2820 NORTHUP WAY STE 200, BELLEVUE, WA 98004(425) 484-4050(425) 488-4050 Get Directions Write a Review

NPPES record last updated: July 2, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jul 2, 2024, Jun 26, 2024 (2 updates tracked since 2024).

About Bellevue Legacy Primary Care Pllc NPPES

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

BELLEVUE LEGACY PRIMARY CARE PLLC (NPI 1619712320) is a healthcare organization registered as a family medicine in Bellevue, Washington and active in the NPI registry since June 2024. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Devin Schock, Physician, as its authorized official.

NPPES Registry Identity

NPI1619712320
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBELLEVUE LEGACY PRIMARY CARE PLLC
Location Address2820 NORTHUP WAY STE 200Bellevue, WA 98004-1498
Mailing Address2820 Northup Way Ste 200Bellevue, WA 98004-1498 · (425) 484-4050 · Fax (425) 488-4050
Phone(425) 484-4050
Fax(425) 488-4050
Organization SubpartNo
Authorized OfficialDevin SchockPhysician · (425) 484-4050
Enumeration DateJune 26, 2024
Last NPPES UpdateJuly 2, 20242 updates tracked since enumeration
NPPES CertifiedJuly 2, 2024
✔ NPI 1619712320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2820 NORTHUP WAY STE 200, Bellevue, WA 98004
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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Bellevue Legacy Primary Care PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Devin Schock, MD
Family Practice
NPI 1649617382
2820 NORTHUP WAY STE 200
Bellevue, WA 98004
(425) 484-4050
✔ PECOS✔ Accepts MedicareSame address
Jenna Donnerberg, MSN, APRN-BC
Nurse Practitioner
NPI 1952132359
15111 229TH DR SE
Monroe, WA 98272
(206) 902-8379
✔ PECOS✔ Accepts Medicare20 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 Waiver 50D2313264

Bellevue Legacy Primary Care PLLC · Bellevue, WA
Active · expires Apr 4, 2028
CLIA Number50D2313264
Laboratory TypePhysician Office
Certificate Effective DateOctober 28, 2024
Certificate Expiration DateApril 4, 2028
Laboratory DirectorDevin P. Schock
Laboratory Phone(425) 484-4050
Laboratory LocationBellevue Legacy Primary Care PLLC2820 Northup Way Ste 200, Bellevue, WA 98004
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 Bellevue Legacy Primary Care PLLC's NPI number?

The NPI number for Bellevue Legacy Primary Care PLLC is 1619712320. It was assigned to this organization in the NPPES registry on June 26, 2024.

Where is Bellevue Legacy Primary Care PLLC located?

Bellevue Legacy Primary Care PLLC is located at 2820 Northup Way Ste 200, Bellevue, WA 98004. The listed phone number is (425) 484-4050.

What is Bellevue Legacy Primary Care PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Bellevue Legacy Primary Care PLLC enrolled in Medicare?

Yes. Bellevue Legacy Primary Care PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Bellevue Legacy Primary Care PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Bellevue Legacy Primary Care PLLC, in Family Practice and Nurse Practitioner. 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, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Bellevue Legacy Primary Care PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2313264) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bellevue Legacy Primary Care PLLC was last updated on July 2, 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.