NPIMap

Organization Active NPI

Western Maryland Health Care Corporation

Doing business as Mountain Laurel Medical Center

  • Federally Qualified Health Center (FQHC)
  • Westernport, MD
National Provider Identifier
1265906994
Registry record updated Jan 21, 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
22221 Westernport Rd SW
Westernport, MD 21562-2206
Phone
(240) 774-0204
Fax
(833) 448-0361
NPI assigned
Jan 16, 2019
Last updated
Jan 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 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 connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

22221 Westernport Rd SW
Westernport, MD 21562-2206

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
7118OtherMDCAREFIRST BC/BS
410467600MedicaidMD
3810007182MedicaidWV
1030070260002MedicaidPA

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
O20190626003165 MD Part A Provider - Federally Qualified Health Center (FQHC) 9436152493 Practice locations: Westernport, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265906994. Details of each certification follow.

Federally qualified health center certification: CCN 211927

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
Jul 8, 2019
Last certification
Jul 8, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1972 in MD
Enrollment address
22221 Westernport Rd SW
Westernport, MD 21562-2206

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.

Ownership & related parties

All disclosed owners & managing parties 18

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
W-2 Managing Employee Jan 6, 2026
Sarah Meredith Call Individual Corporate OfficerCmo Feb 23, 2023
W-2 Managing EmployeeMD; Feb 23, 2023
Pamela Hageman Individual Corporate DirectorBoard Member/Secretary Nov 9, 2018
Robert Stephens Individual Corporate DirectorBoard Member Oct 28, 2025
Rebecca S Aiken Individual Corporate DirectorBoard Member Sep 27, 2021
Cheri Johnson Individual Corporate DirectorBoard Member Jun 27, 2016
Cody Brill Individual Corporate Director Feb 26, 2024
Mary Braden Individual Corporate DirectorBoard Member May 27, 2025
Patricia Lynn Gnegy Individual Corporate DirectorAgent (Credentialing) Sep 30, 2008
W-2 Managing EmployeeCredentialing Specialist Sep 30, 2008
Maira Frantz Individual Corporate OfficerChief of Operations Compliance Jan 19, 2026
W-2 Managing EmployeeChief of Operations & Compliance Jan 19, 2026
Regina Gearhart Individual Corporate DirectorBoard Member Nov 26, 2024
Reanna Miller Individual Corporate Director Nov 6, 2023
James T Coleman Individual Corporate Director Apr 26, 2021
Bryan Frederick Callis Individual Corporate DirectorBoard Member Aug 20, 2018
Julie Yoder Individual Corporate DirectorBoard / Vice Chair Oct 22, 2024
Leah Gregg Individual Corporate DirectorBoard Member/ Treasurer Oct 15, 2021
Kevin Null Individual Corporate DirectorBoard Member/Chair Oct 28, 2025
James W Mou Individual Corporate OfficerCfo Aug 28, 2023
W-2 Managing Employee 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 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768953600000",
    "number": "1265906994",
    "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": "883-448-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22221 WESTERNPORT RD SW",
            "city": "WESTERNPORT",
            "state": "MD",
            "postal_code": "215622206",
            "telephone_number": "240-774-0204",
            "fax_number": "833-448-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MARYLAND HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS",
            "identifier": "7118",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410467600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007182",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030070260002",
            "state": "PA"
        }
    ],
    "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 Westernport, MD

Sources for this page

Verify at the official NPI Registry.