Lakeside Med, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKESIDE MED, LLC

Practice address

723 N Market St
Frederick, MD 21701-5232

Phone

(240) 397-6723

Fax

(833) 992-0865

NPI assigned

Apr 2, 2020

Organization subpart

No

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

Authorized official

Name

Douglas H. Brown, PA-CNPI 1467638502

Title

Primary Member

Phone

(240) 397-6723

Specialties & licenses 1

Addresses

Other names 1

• Mason-Dixon Mobile Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Enrollment records 2

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lakeside Med, LLC

  • Medical Physician Assistant
  • Frederick, MD
  • NPI 1891567053
  NPPES parent name

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas H. Brown, PA-C

  • Physician Assistant
  • Frederick, MD
  • NPI 1467638502

  DC

  Medicare reassignment Care Compare group Authorized official
• Brandy Lynne Cloud, DNP, PMHNP-BC,FNP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort George G Meade, MD
  • NPI 1629382874
  Medicare reassignment Care Compare group NPD
• Mary A McDonald, M.D.

  • Family Medicine Physician
  • Washington, DC
  • NPI 1356447692

  MD

  Medicare reassignment Care Compare group NPD
• Randyl Erik Gessel, PA-C

  • Physician Assistant
  • Frederick, MD
  • NPI 1124285184

  DC

  Medicare reassignment Care Compare group
• Joseph E. Asuncion, MD

  • Family Medicine Physician
  • Hagerstown, MD
  • NPI 1225009400
  Medicare reassignment NPD
• Ruby Jade Ibarra

  • Gerontology Nurse Practitioner
  • Frederick, MD
  • NPI 1720853286
  Medicare reassignment NPD

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1073142147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 N MARKET ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015232",
            "telephone_number": "240-397-6723",
            "fax_number": "833-992-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 N MARKET ST",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217015232",
            "telephone_number": "240-397-6723",
            "fax_number": "833-992-0865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-02",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRIMARY MEMBER",
        "authorized_official_telephone_number": "240-397-6723",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason-Dixon Mobile Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mason-Dixon Mobile Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Frances Lahood, LCSW-C
• Laibon Health LLC
• Monica Ann Laird, OTRL
• Lake Linganore Psychiatry, PLLC
• Sandra L Lake, L.C.S.W.-C.
• Lakeside Med, LLC
• Matthew Lalli
• Hoa T K Lam, DDS
• Briscel Grace Lamas, RBT - 21- 174603
• Marilyn Lamb, LPN

• Family Medicine Physician in Frederick, MD
• Providers in Frederick, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.