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Lifebridge Community Physicians, Inc.

Organization Active NPI Family Medicine Physician · Westminster, MD

NPI 1124486337 · NPPES record last updated Aug 27, 2021

Key facts

NPI
1124486337
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Practice address
688 Poole Rd
Westminster, MD 21157-6166
Phone
(410) 857-8202
NPI assigned
Feb 2, 2016
Organization subpart
No

Authorized official

Name
Mary R Wright-Sisk
Title
Director
Phone
(443) 442-9941

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110627000318 MD Part B Supplier - Clinic/Group Practice 3678751468 Receives reassigned benefits from 358 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Lifebridge Community Physicians Inc (148 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

688 Poole Rd
Westminster, MD 21157-6166

Mailing address

688 Poole Rd
Westminster, MD 21157-6166
Phone (410) 857-8202

Other names

  • Dr. John Middleton Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 27, 2021.

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1124486337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 POOLE RD",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211576166",
            "telephone_number": "410-857-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 POOLE RD",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211576166",
            "telephone_number": "410-857-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-442-9941"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. John Middleton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. John Middleton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westminster, MD

All providers in Westminster, MD · Family Medicine Physician in Maryland

Sources for this page

Verify at the official NPI Registry.