NPIMap

Individual provider Active NPI

Lacie Manthripragada, PA-C

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1982018024
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112408 Issued in FL
Practice address
615 E Princeton St Ste 101
Orlando, FL 32803-1435
Phone
(407) 236-0006
Fax
(407) 236-0007
NPI assigned
Jun 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C05294 MD
Physician Assistant 363A00000X PA9112408 FL Primary

Addresses

Primary practice location

615 E Princeton St Ste 101
Orlando, FL 32803-1435

Mailing address

615 E Princeton St Ste 101
Orlando, FL 32803-1435
Phone (407) 236-0006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140818000546 MD Practitioner - Physician Assistant 5799902664 Reassigns benefits to 3 organizations
I20260318002966 DC Practitioner - Physician Assistant 5799902664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Luminis Health Medical Group, LLCGroup PAC ID 2860447315, 540 clinicians

Practice addresses (Care Compare)

1000 Bestgate Rd
Suite 400
Annapolis, MD 21401-3371
Phone (410) 266-2720

2001 Medical Pkwy
Annapolis, MD 21401-3280
Phone (443) 481-1000

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

Merit-based Incentive Payment System (MIPS)

Final score
81.45 of 100Reported as group
Quality
67.28
Promoting interoperability
98
Improvement activities
40
Cost
72.57

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9112408FLMDPhysician Assistant
C05294MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland General Clinical Practice Group, Inc. CurrentSince Jun 1, 2014 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Feb 9, 2026 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 1, 2022 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Oct 1, 2022 Accepting new patients
Johns Hopkins University CurrentSince Nov 2, 2015 Accepting new patients
Johns Hopkins University CurrentSince Nov 2, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

827 Linden Ave
Baltimore, MD 21201
Phone (410) 225-8100

600 N Wolfe St
Baltimore, MD 21287

1630 Main St
Ste 213
Chester, MD 21619
Phone (443) 481-5300

Organizations & group practices 11

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 2

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": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1982018024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E PRINCETON ST STE 101",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031435",
            "telephone_number": "407-236-0006",
            "fax_number": "407-236-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E PRINCETON ST STE 101",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031435",
            "telephone_number": "407-236-0006",
            "fax_number": "407-236-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTHRIPRAGADA",
        "first_name": "LACIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C05294",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.