NPIMap

Organization Active NPI

Lifespan Physician Group, Inc.

Doing business as Brown Health Medical Group

  • General Practice Physician
  • Providence, RI
National Provider Identifier
1407116643
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LIFESPAN PHYSICIAN GROUP, INC.
Doing business as
Brown Health Medical Group
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-6779
Fax
(401) 444-6912
NPI assigned
May 22, 2012
Last updated
Oct 7, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFESPAN CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Authorized official

Name
Mr. Peter K Markell
Title
Evp & Cfo
Phone
(401) 444-7914

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X
Optometrist 152W00000X
Transplant Surgery Physician 204F00000X
Critical Care Medicine (Anesthesiology) Physician 207LC0200X
Obstetrics & Gynecology Physician 207V00000X
Plastic Surgery Physician 208200000X
Surgery Physician 208600000X
Surgical Critical Care Physician 2086S0102X
Pediatric Surgery Physician 2086S0120X
Trauma Surgery Physician 2086S0127X
Vascular Surgery Physician 2086S0129X
Surgical Oncology Physician 2086X0206X
Colon & Rectal Surgery Physician 208C00000X
General Practice Physician 208D00000X Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

117 Ellenfield St
Suite 101
Providence, RI 02905-4513
Phone (401) 444-6779

Other names 1

  • Brown Health Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121026000023 MA Part B Supplier - Clinic/Group Practice 2567455082 Receives reassigned benefits from 57 practitioners
Practice locations: Attleboro, MA; South Attleboro, MA; North Attleboro, MA; Fall River, MA
O20121029000368 RI Part B Supplier - Clinic/Group Practice 2567455082 Receives reassigned benefits from 1,439 practitioners
6 other NPIs on this enrollment

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lifespan Corporation

Locations

1500 Pontiac Ave
Ste 107
Cranston, RI 02920
Phone (401) 444-5495

900 Warren Ave
Ste 302
East Providence, RI 02914
Phone (401) 444-8344

950 Warren Ave
Ste 104
East Providence, RI 02914
Phone (401) 606-0606

950 Warren Ave
Ste 301
East Providence, RI 02914
Phone (401) 444-3611

950 Warren Ave
Ste 302
East Providence, RI 02914
Phone (401) 444-2701

11 Friendship St
#1
Newport, RI 02840
Phone (401) 845-1646

19 Friendship St
Apt 150160
Newport, RI 02840

19 Friendship St
Ste 150160
Newport, RI 02840
Phone (401) 845-3800

164 Summit Ave
#C70
Providence, RI 02906
Phone (401) 793-3922

164 Summit Ave
Ste C
Providence, RI 02906
Phone (401) 793-2931

195 Collyer St
Ste 201
Providence, RI 02904
Phone (401) 421-0710

2 Dudley St
Ste 180
Providence, RI 02905
Phone (401) 228-0558

2 Dudley St
Ste 190
Providence, RI 02905
Phone (401) 228-0555

593 Eddy St
#2S
Providence, RI 02903
Phone (401) 444-5943

593 Eddy St
Bldg 1ST
Providence, RI 02903
Phone (401) 444-5803

66 Branch Ave
Providence, RI 02904
Phone (401) 414-4147

66 Branch Ave
Ste 150
Providence, RI 02904
Phone (401) 606-2590

690 Eddy St
#2
Providence, RI 02903
Phone (401) 793-9166

765 Allens Ave
Ste 104
Providence, RI 02905
Phone (401) 606-8080

Practitioners & affiliated clinicians

Practitioners 1,482

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 1,482

NPI Registry JSON

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759795200000",
    "number": "1407116643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PHYSICIAN GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPAN CORPORATION",
        "enumeration_date": "2012-05-22",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "MARKELL",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "401-444-7914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brown Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; 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.