Active NPI
Lisa Lacarrubba, M.D.
- Family Medicine Physician
- Baltimore, MD
National Provider Identifier
1962589432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- D0095650
- Practice address
- 1501 S Clinton St
Baltimore, MD 21224-5730 - Phone
- (866) 233-6925
- Fax
- (410) 866-8606
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0420010047 | VT | |
| Family Medicine Physician | 207Q00000X | 25MA06802900 | NJ | |
| Family Medicine Physician | 207Q00000X | D0095650 | MD | Primary |
Addresses
Primary practice location
1501 S Clinton St
Baltimore, MD 21224-5730
Mailing address
1501 S Clinton St
Baltimore, MD 21224-5730
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 349703 | Other | VT | MVP |
| 00049423 | Other | VT | BLUE SHIELD |
| 8000700 | Other | VT | LADIES FIRST |
| 080158933 | Other | VT | RAILROAD MEDICARE |
| 0VN2307 | Medicaid | VT |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4550 Montgomery Ave
Suite 1050N
Bethesda, MD 20814-3304
4550 Montgomery Ave
Suite 1050N
Bethesda, MD 20814-3323
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA06802900 | NJ | MD | Family Medicine Physician |
| 0420010047 | VT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlas Health, LLC | Family Medicine | Current | Accepting new patients |
| North Country Hospital & Health Center Inc | Past | Accepting new patients |
Locations
1501 S Clinton St
Baltimore, MD 21224
Phone (443) 562-2536
Interoperability endpoints
- lisa.lacarrubba@778128272654340.direct.elationemr.com
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Baltimore, MD
- NPI 1548839012
-
- Critical Access Hospital
- Newport, VT
- NPI 1144251059
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735257600000",
"number": "1962589432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 S CLINTON ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212245730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S CLINTON ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212245730",
"telephone_number": "866-233-6925",
"fax_number": "410-866-8606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACARRUBBA",
"first_name": "LISA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2024-12-27",
"certification_date": "2024-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VT",
"license": "0420010047",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NJ",
"license": "25MA06802900",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "D0095650",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "349703",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00049423",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LADIES FIRST",
"identifier": "8000700",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080158933",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0VN2307",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.