LEGACY HEALTH CLINIC, LLC
NPI 1942670005
Nurse Practitioner - Adult Health in Ketchikan, AK
About Legacy Health Clinic, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LEGACY HEALTH CLINIC, LLC (NPI 1942670005) is a healthcare organization registered as an adult health in Ketchikan, Alaska and active in the NPI registry since October 2015. The organization holds a CLIA Waiver certificate valid through October 15, 2027 and lists Helen R Klein, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 4
Group Practice 1
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 Health Clinic, 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 Health Clinic, LLC, which bills Medicare for the services they deliver. Of these, 1 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 02D2103660
Legacy Health Clinic, LLC · Ketchikan, AKFrequently 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 Health Clinic, LLC's NPI number?
The NPI number for Legacy Health Clinic, LLC is 1942670005. It was assigned to this organization in the NPPES registry on October 1, 2015.
Where is Legacy Health Clinic, LLC located?
Legacy Health Clinic, LLC is located at 3524 Tongass Ave, Ketchikan, AK 99901. The listed phone number is (907) 225-6355.
What is Legacy Health Clinic, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.
Is Legacy Health Clinic, LLC enrolled in Medicare?
Yes. Legacy Health Clinic, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Legacy Health Clinic, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Legacy Health Clinic, 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, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Legacy Health Clinic, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 02D2103660) is associated with this NPI, valid through October 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Legacy Health Clinic, LLC was last updated on October 1, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Legacy Health Clinic, Llc · NPI 1942670005
Adult Health organization in Ketchikan, Alaska. Organization record, active in the CMS NPPES registry since October 1, 2015.
## Identity
- **NPI:** 1942670005 (Entity type: Organization)
- **Enumerated:** October 1, 2015
- **Primary specialty:** Nurse Practitioner - Adult Health · taxonomy 363LA2200X
- **Organization subpart:** No
- **Authorized official:** Helen Klein, OWNER
## Practice location
- **Address:** 3524 TONGASS AVE, Ketchikan, AK 99901-5635
- **Phone:** (907) 225-6355
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 1, 2015
- **Other identifiers:** Medicaid 1580081 (AK); Medicare PIN K164537 (AK); Medicaid 1022301 (AK); and 1 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1942670005) · Data from the CMS NPPES public registry.