DR. JACALYN BLACKWELL-WHITE
NPI 1194170027
Pediatrics - Adolescent Medicine in Randallstown, MD
About Dr. Jacalyn Blackwell-white NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. JACALYN BLACKWELL-WHITE (NPI 1194170027) is a healthcare organization registered as an adolescent medicine in Randallstown, Maryland and active in the NPI registry since April 2016. The organization maintains a secondary practice location in Baltimore and lists Mary Wright-sisk, Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Secondary Practice Location 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Jacalyn Blackwell-white is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Dr. Jacalyn Blackwell-White, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (5)
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 Lifebridge Suburban Physician Group II LLC's NPI number?
The NPI number for Lifebridge Suburban Physician Group II LLC is 1194170027. It was assigned to this organization in the NPPES registry on April 28, 2016. The provider is doing business as Dr. Jacalyn Blackwell-White.
Where is Lifebridge Suburban Physician Group II LLC located?
Lifebridge Suburban Physician Group II LLC is located at 5400 Old Court Rd Ste 300B, Randallstown, MD 21133. The listed phone number is (410) 521-7337.
What is Lifebridge Suburban Physician Group II LLC's specialty?
The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.
Is Lifebridge Suburban Physician Group II LLC enrolled in Medicare?
Yes. Lifebridge Suburban Physician Group II LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lifebridge Suburban Physician Group II LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Lifebridge Suburban Physician Group II LLC. 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. The largest specialties are Pediatric Medicine (3) and Nurse Practitioner (2). Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Lifebridge Suburban Physician Group II LLC was last updated on August 31, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Dr. Jacalyn Blackwell-White · NPI 1194170027
Adolescent Medicine organization in Randallstown, Maryland. Organization record, active in the CMS NPPES registry since April 28, 2016.
## Identity
- **NPI:** 1194170027 (Entity type: Organization)
- **Enumerated:** April 28, 2016
- **Primary specialty:** Pediatrics - Adolescent Medicine · taxonomy 2080A0000X
- **Legal business name:** Lifebridge Suburban Physician Group Ii Llc
- **Organization subpart:** Yes (part of Lifebridge Community Physicians, Inc.)
- **Authorized official:** Mary Wright-Sisk, DIRECTOR
## Practice location
- **Address:** 5400 OLD COURT RD STE 300B, Randallstown, MD 21133-5100
- **Phone:** (410) 521-7337 · **Fax:** (410) 521-7377
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Pediatric Medicine (3), Nurse Practitioner (2); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 31, 2021
---
Source: [NPI Profile](https://npiprofile.com/npi/1194170027) · Data from the CMS NPPES public registry.