Individual provider Active NPI

Lisa M Marroney, PA-C

  • Surgical Physician Assistant
  • Randallstown, MD
National Provider Identifier
1528029600
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
C0002996 Issued in MD
Practice address
5401 Old Court Rd
Dept. of Surgery
Randallstown, MD 21133-5103
Phone
(410) 521-2200
NPI assigned
Mar 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X C0002996 MD Primary

Addresses

Primary practice location

5401 Old Court Rd
Dept. of Surgery
Randallstown, MD 21133-5103

Mailing address

5401 Old Court Rd
Attn: Credentialing
Randallstown, MD 21133-5103
Phone (410) 601-5524

Other names 1

  • Lisa M Jacobson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041220000685 MD Practitioner - Physician Assistant 2567429756 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shock Trauma Associates PAGroup PAC ID 6800882317, 258 clinicians

Practice addresses (Care Compare)

22 S Green St
Baltimore, MD 21201-1544
Phone (410) 328-6704

Hospital & facility affiliations

  • University of Maryland Medical Center Hospital, Baltimore, MD, CCN 210002

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0002996MDMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Hospital Center, Inc. Past Accepting new patients
Saint Joseph Medical Center , Inc. Past Accepting new patients
St. Joseph Physician Enterprise Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lmarroney131913@direct.umm.edu
  • FHIR API: https://fhir-myrecord.cerner.com/r4/136fea15-c667-40bc-9ed2-b1115d62123b/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1528029600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "address_2": "ATTN: CREDENTIALING",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-601-5524",
            "fax_number": "410-601-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "address_2": "DEPT. OF SURGERY",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-521-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRONEY",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-29",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0002996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "JACOBSON",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Randallstown, MD

Sources for this page

Verify at the official NPI Registry.