NPIMap

Organization Active NPI

Lifebridge Community Physicians, Inc

  • Internal Medicine Physician
  • Edgewood, MD
National Provider Identifier
1346513538
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0068088 Issued in MD
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Doing business as
Lifebridge Health Medical Group
Practice address
1401 Pulaski Hwy
Suite M
Edgewood, MD 21040-1398
Phone
(410) 671-9241
Fax
(410) 671-9242
NPI assigned
Feb 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
Mr. Mary R Wright-Sisk
Title
Vice President
Phone
(443) 422-9941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X D0068088 MD Primary

Addresses

Primary practice location

1401 Pulaski Hwy
Suite M
Edgewood, MD 21040-1398

Mailing address

1401 Pulaski Hwy
Suite M
Edgewood, MD 21040-1398
Phone (410) 671-9241

Other identifiers 1

IdentifierTypeStateIssuer
970084600MedicaidMD

Other names 1

  • Lifebridge Health Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

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

National Provider Directory
Tax ID family
Lifebridge Community Physicians Inc148 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1346513538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 PULASKI HWY",
            "address_2": "SUITE M",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210401398",
            "telephone_number": "410-671-9241",
            "fax_number": "410-671-9242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 PULASKI HWY",
            "address_2": "SUITE M",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210401398",
            "telephone_number": "410-671-9241",
            "fax_number": "410-671-9242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-17",
        "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": "VICE PRESIDENT",
        "authorized_official_telephone_number": "443-422-9941",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0068088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "970084600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifebridge Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lifebridge Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgewood, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.