WELLNESS LEGACY LLC
NPI 1992433916
Nurse Practitioner - Psychiatric/Mental Health in Towson, MD
About Wellness Legacy Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WELLNESS LEGACY LLC (NPI 1992433916) is a healthcare organization registered as a psychiatric/mental health in Towson, Maryland and active in the NPI registry since August 2022. The organization lists Mark Anthony Bergonia Ison, Co -owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
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)
Wellness Legacy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Wellness Legacy LLC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
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 Wellness Legacy LLC's NPI number?
The NPI number for Wellness Legacy LLC is 1992433916. It was assigned to this organization in the NPPES registry on August 9, 2022.
Where is Wellness Legacy LLC located?
Wellness Legacy LLC is located at 1016 Dulaney Valley Rd, Towson, MD 21204. The listed phone number is (410) 286-1258.
What is Wellness Legacy LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Wellness Legacy LLC enrolled in Medicare?
Yes. Wellness Legacy LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wellness Legacy LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Wellness Legacy 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, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Wellness Legacy LLC was last updated on March 27, 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.
# Wellness Legacy Llc · NPI 1992433916
Psychiatric/Mental Health organization in Towson, Maryland. Organization record, active in the CMS NPPES registry since August 9, 2022.
## Identity
- **NPI:** 1992433916 (Entity type: Organization)
- **Enumerated:** August 9, 2022
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** Yes (part of Wellness Legacy Llc)
- **Authorized official:** Mark Anthony Ison, CO -OWNER
## Practice location
- **Address:** 1016 DULANEY VALLEY RD, Towson, MD 21204-2702
- **Phone:** (410) 286-1258
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 3 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 27, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1992433916) · Data from the CMS NPPES public registry.