Lifebridge Suburban Physician Group II LLC
NPI 1194170027 · Pediatric Adolescent Medicine Physician · Randallstown, MD
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Lifebridge Suburban Physician Group II LLC is a Pediatric Adolescent Medicine Physician organization in Randallstown, MD (NPI 1194170027).
Provider details
- NPI number
- 1194170027
- Entity type
- Organization
- Primary specialty
- Pediatric Adolescent Medicine PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Lifebridge Community Physicians, Inc.
- Organization subpart
- Yes
- Authorized official
- Mary Wright-Sisk, Director(443) 422-9941
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Dr. Jacalyn Blackwell-White
- Doing business as
- Dr. Jacalyn Blackwell-White
Additional practice locations (1)
- 3527 N Rolling Rd# 1Baltimore, MD 21244-2223Phone: (410) 521-7337
Registry dates
- Enumerated
- 2016-04-28
- Last updated
- 2021-08-31
- Certified
- 2021-08-31
Frequently asked questions
- What is Lifebridge Suburban Physician Group II LLC's NPI number?
- Lifebridge Suburban Physician Group II LLC's National Provider Identifier (NPI) is 1194170027, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Lifebridge Suburban Physician Group II LLC?
- Lifebridge Suburban Physician Group II LLC is classified in the NPPES registry as Pediatric Adolescent Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Lifebridge Suburban Physician Group II LLC located?
- Lifebridge Suburban Physician Group II LLC's practice location on file with NPPES is 5400 Old Court Rd Ste 300b, Randallstown, MD 21133-5100.
- What is Lifebridge Suburban Physician Group II LLC's phone number?
- The practice phone number listed in the NPPES registry for Lifebridge Suburban Physician Group II LLC is (410) 521-7337.
- Does Lifebridge Suburban Physician Group II LLC accept Medicare?
- Lifebridge Suburban Physician Group II LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Lifebridge Suburban Physician Group II LLC?
- The authorized official listed on Lifebridge Suburban Physician Group II LLC's NPPES record is Mary Wright-Sisk, Director. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Lifebridge Suburban Physician Group II LLC's NPI active?
- Yes — Lifebridge Suburban Physician Group II LLC's NPI (1194170027) is active in the NPPES registry as of the last update on 2021-08-31.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.