NPIMap

Organization Active NPI

Western Maryland Health Care Corporation

Doing business as Mountain Laurel Medical Center

  • Federally Qualified Health Center (FQHC)
  • Bruceton Mills, WV
National Provider Identifier
1679269807
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
198 Morgantown St Ste 2
Bruceton Mills, WV 26525-5003
Phone
(304) 379-7600
Fax
(833) 448-0358
NPI assigned
Apr 12, 2023
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 1

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

Addresses

Primary practice location

198 Morgantown St Ste 2
Bruceton Mills, WV 26525-5003

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 WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230804000854 WV Part B Supplier - Clinic/Group Practice 9436152493 Receives reassigned benefits from 8 practitioners
Practice locations: Bruceton Mills, WV
O20230821001333 WV Part A Provider - Federally Qualified Health Center (FQHC) 9436152493 Practice locations: Bruceton Mills, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679269807. Details of each certification follow.

Federally qualified health center certification: CCN 581023

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
Aug 21, 2023
Last certification
Aug 21, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1972 in MD
Enrollment address
198 Morgantown St
Ste 2
Bruceton Mills, WV 26525-5003

Other NPIs with the same Medicare PAC ID 5

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

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 EmployeeAd;Ceo 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 Director Jun 27, 2016
Cody Brill Individual Corporate DirectorBoard Member Feb 26, 2024
Mary Braden Individual Corporate DirectorBoard Member May 27, 2025
Patricia Lynn Gnegy Individual W-2 Managing EmployeeCredentialing Specialist/ Agent Sep 30, 2008
Maira Frantz Individual Corporate OfficerChief of Operations & Compliance Jan 19, 2026
W-2 Managing EmployeeAd;Chief of Operations & Compliance Jan 19, 2026
Regina Gearhart Individual Corporate DirectorBoard Member Jul 11, 1968
Reanna Miller Individual Corporate DirectorBoard Member Nov 6, 2023
James T Coleman Individual Corporate DirectorBoard Member Apr 26, 2021
Bryan Frederick Callis Individual Corporate DirectorBoard Member Aug 20, 2018
Julie Yoder Individual Corporate DirectorBoard Member / 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 EmployeeAd;Cfo 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 70

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 70

NPI Registry JSON

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

{
    "created_epoch": "1681257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768953600000",
    "number": "1679269807",
    "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": "198 MORGANTOWN ST STE 2",
            "city": "BRUCETON MILLS",
            "state": "WV",
            "postal_code": "265255003",
            "telephone_number": "304-379-7600",
            "fax_number": "833-448-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MARYLAND HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-12",
        "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
        }
    ],
    "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 Bruceton Mills, WV

Sources for this page

Verify at the official NPI Registry.