Dorchester Family Medicine, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0080826 Issued in MD

Legal business name

DORCHESTER FAMILY MEDICINE, LLC

Practice address

300 Dorchester Ave
Cambridge, MD 21613-2420

Phone

(410) 228-2603

NPI assigned

Jul 25, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Sara Coulbourn, MDNPI 1780020289

Title

Owner

Phone

(410) 228-2603

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Sara Wozny Coulbourn, M.D.

  • Family Medicine Physician
  • Cambridge, MD
  • NPI 1780020289

  MD

  Medicare reassignment Care Compare group Authorized official
• Maryjo Elizabeth Paul, FNP-C

  • Family Medicine Physician
  • Cambridge, MD
  • NPI 1023861929

  MD

  Medicare reassignment Care Compare group
• Lauren Samuel, CRNP, FNP-C

  • Family Nurse Practitioner
  • Cambridge, MD
  • NPI 1336647056

  MD

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1912484668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 GARY CREEK RD",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216133312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 DORCHESTER AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216132420",
            "telephone_number": "410-228-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DORCHESTER FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "COULBOURN",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-228-2603",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0080826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorchester County Health Department - SBWC-MH - Sandy Hill
• Dorchester County Health Department - SBWC-MH-CSD
• Dorchester County Health Dept
• Dorchester County Public Schools
• Dorchester County Public Schools Infant & Toddler Program
• Dorchester Health & Wellness LLC
• Dr Jani Associates, LLC
• Dr. Jani Associates, LLC
• Dr. William E. Bair LLC
• Margaret Elizabeth Dressel

• All providers in Cambridge, MD
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.