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MASON-DIXON MOBILE MEDICINE
NPI 1073142147
Family Medicine in Frederick, MD

Active since April 02, 2020
723 N MARKET ST, FREDERICK, MD 21701(240) 397-6723(833) 992-0865 Get Directions Write a Review

NPPES record last updated: January 11, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jan 11, 2022, Nov 16, 2021, Apr 2, 2020 (3 updates tracked since 2020).

About Mason-dixon Mobile Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASON-DIXON MOBILE MEDICINE (NPI 1073142147) is a healthcare organization registered as a family medicine in Frederick, Maryland and active in the NPI registry since April 2020. The organization lists Douglas H. Brown, Primary Member, as its authorized official.

NPPES Registry Identity

NPI1073142147
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAKESIDE MED, LLC
Location Address723 N MARKET STFrederick, MD 21701-5232
Mailing Address723 N Market StFrederick, MD 21701-5232 · (240) 397-6723 · Fax (833) 992-0865
Phone(240) 397-6723
Fax(833) 992-0865
Organization SubpartNo
Authorized OfficialDouglas H. BrownPrimary Member · (240) 397-6723
Enumeration DateApril 2, 2020
Last NPPES UpdateJanuary 11, 20223 updates tracked since enumeration
NPPES CertifiedJanuary 11, 2022
✔ NPI 1073142147 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
723 N MARKET ST, Frederick, MD 21701
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Other Names 1

Doing Business AsMason-dixon Mobile Medicine

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mason-dixon Mobile Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Mason-Dixon Mobile Medicine, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Ruby Ibarra
Nurse Practitioner
NPI 1720853286
814 TOLL HOUSE AVE
Frederick, MD 21701
(301) 662-8310
✔ PECOS✔ Accepts Medicare0.3 mi
Joseph Asuncion, MD
Family Practice
NPI 1225009400
11110 MEDICAL CAMPUS RD STE 200
Hagerstown, MD 21742
(301) 714-4400
✔ PECOS✔ Accepts Medicare20 mi
Mary Mcdonald, M.D.
Preventive Medicine
NPI 1356447692
3720 UPTON ST NW
Washington, DC 20016
(202) 966-3720
✔ PECOS✔ Accepts Medicare38 mi
Brandy Cloud, DNP, PMHNP-BC,FNP-C
Nurse Practitioner
NPI 1629382874
2480 LLEWELLYN AVE STE 5800
Fort George G Meade, MD 20755
(301) 619-7175
✔ PECOS43 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Med, LLC's NPI number?

The NPI number for Lakeside Med, LLC is 1073142147. It was assigned to this organization in the NPPES registry on April 2, 2020. The provider is doing business as Mason-Dixon Mobile Medicine.

Where is Lakeside Med, LLC located?

Lakeside Med, LLC is located at 723 N Market St, Frederick, MD 21701. The listed phone number is (240) 397-6723.

What is Lakeside Med, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Lakeside Med, LLC enrolled in Medicare?

Yes. Lakeside Med, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lakeside Med, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Lakeside Med, LLC, in Family Practice, Nurse Practitioner and Preventive Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Lakeside Med, LLC was last updated on January 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.