OrganizationActive
Legacy Medical LLC
NPI 1619594637 · Adult Medicine Physician · Bismarck, ND
Provider details
- NPI number
- 1619594637
- Entity type
- Organization
- Primary specialty
- Adult Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jill Wilson, Chief Operating Officer(701) 516-4637
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(64/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
600 S 2nd St Ste 200
Bismarck, ND 58504-5729
Phone: (701) 516-4637
Fax: (877) 651-1381
Street-level locationGet directions
Mailing address
Po Box 13238
Grand Forks, ND 58208-3238
Registry dates
- Enumerated
- 2020-06-26
- Last updated
- 2023-03-03
- Certified
- 2023-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.