NPIMap

Mark Brady, M.D.

Individual provider Active NPI Emergency Medicine Physician · Providence, RI

NPI 1265660294 · NPPES record last updated Oct 6, 2020

Key facts

NPI
1265660294
Entity type
Individual (NPI type 1)
Primary specialty
Emergency Medicine Physician 207P00000X
License
MD17161 (RI)
Practice address
593 Eddy St
Claverick 2
Providence, RI 02903-0290
Phone
(014) 444-4000
NPI assigned
Jun 29, 2009
Sex
Male
Sole proprietor
No

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Medicare Care Compare profile

Specialty
Emergency Medicine
Education
Warren Alpert Medical School of Brown University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group Inc (1,151 clinicians)
Brown Emergency Medicine (140 clinicians)

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-7024

Hospital & facility affiliations

  • Newport Hospital Hospital · Newport, RI · CCN 410006
  • Rhode Island Hospital Hospital · Providence, RI · CCN 410007
  • The Miriam Hospital Hospital · Providence, RI · CCN 410012

Medicare participation

Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20201012001970 RI Practitioner - Emergency Medicine 6901068758 Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD)
No
HHS exclusion list flag
The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. Current
since Dec 1, 2020		 Accepting new patients
Lifespan Physician Group, Inc. Current Accepting new patients
Lifespan Physician Group, Inc. Emergency Medicine Current
since Dec 1, 2020		 Accepting new patients
Brown Emergency Medicine Emergency Medicine Current
since Oct 1, 2020		 Accepting new patients
Usacs of Connecticut, LLC Emergency Medicine Past Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

593 Eddy St
#2
Providence, RI 02903
Phone (401) 519-1604

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

593 Eddy St
Providence, RI 02903

125 Whipple St
Ste 3
Providence, RI 02908
Phone (401) 854-2504

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 050700 CT
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X MD17161 RI Yes

Addresses

Primary practice location

593 Eddy St
Claverick 2
Providence, RI 02903-0290

Mailing address

125 Whipple St Ste 3
Providence, RI 02908-3258
Phone (401) 519-0337

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 6, 2020.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1265660294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WHIPPLE ST STE 3",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029083258",
            "telephone_number": "401-519-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "CLAVERICK 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029030290",
            "telephone_number": "014-444-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "050700",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "RI",
            "license": "MD17161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

All providers in Providence, RI · Emergency Medicine Physician in Rhode Island

Sources for this page

Verify at the official NPI Registry.