NPIMap

Organization Active NPI

Western Maryland Health Care Corporation

Doing business as Mountain Laurel Medical Center

  • Federally Qualified Health Center (FQHC)
  • Grantsville, MD
National Provider Identifier
1053727065
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WESTERN MARYLAND HEALTH CARE CORPORATION
Doing business as
Mountain Laurel Medical Center
Practice address
28 Hershberger LN
Grantsville, MD 21536-1172
Phone
(301) 895-5107
Fax
(833) 448-0359
NPI assigned
Jul 10, 2014
Last updated
Mar 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Michelle K Dixon, CRNPNPI 1760972079
Title
Ceo
Phone
(301) 533-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

28 Hershberger LN
Grantsville, MD 21536-1172

Mailing address

1027 Memorial Dr
Oakland, MD 21550-4343
Phone (301) 533-3300

Other names 1

  • Mountain Laurel Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080131000575 MD Part B Supplier - Clinic/Group Practice 9436152493 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grantsville, MD; Oakland, MD; Westernport, MD
O20141030001719 MD Part A Provider - Federally Qualified Health Center (FQHC) 9436152493 Practice locations: Grantsville, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053727065. Details of each certification follow.

Federally qualified health center certification: CCN 211894

Legal name
WESTERN MARYLAND HEALTH CARE CORPORATION
Doing business as
MOUNTAIN LAUREL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2014
Last certification
Oct 30, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 13, 1973 in MD
Enrollment address
28 Hershberger LN
Grantsville, MD 21536-1172

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mountain Laurel Medical Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

28 Hershberger Ln
Grantsville, MD 21536
Phone (301) 895-5107

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michelle Kelly Dixon Individual Corporate OfficerCeo Jan 6, 2026
Sarah Meredith Call Individual Corporate DirectorCmo Feb 23, 2023
Pamela Hageman Individual Corporate DirectorBoard Member Nov 9, 2018
Robert Stephens Individual OtherBoard Member Oct 28, 2025
Rebecca S Aiken Individual Corporate Director Sep 27, 2021
Cody Brill Individual Corporate DirectorBoard Member Feb 26, 2024
Mary Braden Individual OtherBoard Member May 27, 2025
Patricia Lynn Gnegy Individual W-2 Managing EmployeeAgent/ Credentialing Specialist Sep 30, 2008
Maira Frantz Individual Corporate OfficerChief of Operations & Compliance Jan 19, 2026
Regina Gearhart Individual OtherBoard Member Nov 26, 2024
Reanna Miller Individual Corporate DirectorBoard Member Nov 6, 2023
Bryan Frederick Callis Individual Corporate DirectorBoard Member Aug 20, 2018
Julie Yoder Individual OtherBoard Member Oct 22, 2025
Leah Gregg Individual Corporate DirectorBoard Member Oct 15, 2021
Kevin Null Individual OtherBoard Member Chairperson Oct 28, 2025
James W Mou Individual Corporate OfficerCfo Aug 28, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1053727065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 MEMORIAL DR",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215504343",
            "telephone_number": "301-533-3300",
            "fax_number": "833-448-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 HERSHBERGER LN",
            "city": "GRANTSVILLE",
            "state": "MD",
            "postal_code": "215361172",
            "telephone_number": "301-895-5107",
            "fax_number": "833-448-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MARYLAND HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-10",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-533-3300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Laurel Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Laurel Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grantsville, MD

Sources for this page

Verify at the official NPI Registry.