Individual provider Active NPI

Lisa Lacarrubba, M.D.

  • Family Medicine Physician
  • Baltimore, MD
National Provider Identifier
1962589432
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0095650 Issued in MD
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

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
349703OtherVTMVP
00049423OtherVTBLUE SHIELD
8000700OtherVTLADIES FIRST
080158933OtherVTRAILROAD MEDICARE
0VN2307MedicaidVT

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230405003135 MD Practitioner - Family Practice 0143238196 Reassigns benefits to 1 organization

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

LicenseStateTypeSpecialty
25MA06802900NJMDFamily Medicine Physician
0420010047VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atlas Health, LLC Family Medicine CurrentSince Dec 2, 2022 Accepting new patients
North Country Hospital & Health Center Inc PastSince Jul 1, 2007 Accepting new patients

Locations

1501 S Clinton St
Baltimore, MD 21224
Phone (443) 562-2536

Interoperability endpoints

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.