Lifespan Physician Group, Inc.
Organization Active NPI Anesthesiology Physician · Providence, RI
NPI 1053782466 · NPPES record last updated Mar 30, 2026
Key facts
- NPI
- 1053782466
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- LIFESPAN PHYSICIAN GROUP, INC.
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-5172
- Fax
- (401) 444-5090
- NPI assigned
- Oct 12, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Peter K Markell
- Title
- Evp & Cfo
- Phone
- (401) 444-7914
Other NPIs with the same Medicare PAC ID 3
Practitioners 1,169
-
Abey Sam Abraham, MBCHB
-
Rabia Amir, MD
-
Shyamal R Asher, MD
-
Danny Duc Bui, MD
-
Maria Paula Ramos Caramez, MD, PHD
-
Michele Cerce, CRNA
-
Alexander D Cohen, M.D.
-
Ashley Erin Desjardins, MSN, CRNA
-
Abigail Finger, MD
-
Zachary A Gandee, MD
-
George A. Garcia, M.D.
-
Gasper Gasperlin, DO
-
Melanie E Gelfand, M.D.
-
Cheryl-Ann Gomez, MD
-
Stephanie Grzych, CRNA
-
Jenny Han, MD
-
Geoffrey L Hayward, M.D.
-
Henry Huang, MD
-
Laurie Jean Isabella, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160121000235 | RI | Part B Supplier - Clinic/Group Practice | 2567455082 |
Receives reassigned benefits from 107 practitioners Practice locations: Newport, RI; Providence, RI; Riverside, RI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| Certified Registered Nurse Anesthetist |
367500000X |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (401) 444-6779
Other practice location 1
62 Amaral St
Riverside, RI 02915-2205
Phone (401) 649-4970
Other practice location 2
164 Summit Ave
Providence, RI 02906-2853
Phone (401) 444-5172
Other practice location 3
11 Friendship St
Newport, RI 02840-2209
Phone (401) 444-5172
Other practice location 4
101 Dudley St
Providence, RI 02905-2401
Phone (401) 444-5172
Other names
- Brown Health Medical Group
Other providers in Providence, RI
- Lifespan Pharmacy, LLC
- Lifespan Pharmacy, LLC
- Lifespan Pharmacy, LLC
- Lifespan Physician Group Inc
- Lifespan Physician Group Inc
- Lifespan Physician Group, Inc.
- Lifespan Physician Group, Inc.
- Lifespan Physician Group, Inc.
- Lifespan Physician Group, Inc.
- Lifespan Physician Group, Inc.
All providers in Providence, RI · Anesthesiology Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.