NPIMap

Organization Active NPI

Lifespan Physician Group Inc

  • Ambulatory Surgical Clinic/Center
  • East Providence, RI
National Provider Identifier
1134078868
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
LIFESPAN PHYSICIAN GROUP INC
Doing business as
BROWN HEALTH MEDICAL GROUP
Brown Health Medical Group Endoscopy Center
Practice address
62 Amaral Street
East Providence, RI 02915
Phone
(401) 649-4030
Fax
(401) 649-4031
NPI assigned
Jan 26, 2026
Organization subpart
Yes
Parent organization
LIFESPAN PHYSICIAN GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna Gordon
Title
Director Professional Revenue Ops
Phone
(401) 443-5107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

62 Amaral Street
East Providence, RI 02915

Mailing address

15 La Salle SQ
Providence, RI 02903-1814

Other names 2

  • BROWN HEALTH MEDICAL GROUP Doing business as
  • Brown Health Medical Group Endoscopy Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D2146344Brown Medicine Endoscopy Center62 Amaral St, East Providence, RI 02915Certificate of waiverMar 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Roger D Raymond MD8 organizations share this tax ID, including this one
Part of
Roger D Raymond MD

Other organizations with this tax ID 7

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

Locations

62 Amaral St
Riverside, RI 02915
Phone (401) 649-4030

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1134078868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LA SALLE SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 AMARAL STREET",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "02915",
            "telephone_number": "401-649-4030",
            "fax_number": "401-649-4031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PHYSICIAN GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPAN PHYSICIAN GROUP INC",
        "enumeration_date": "2026-01-26",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "DIRECTOR PROFESSIONAL REVENUE OPS",
        "authorized_official_telephone_number": "401-443-5107"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROWN HEALTH MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brown Health Medical Group Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.