NPIMap

Organization Active NPI

Lifespan Physician Group, Inc.

  • 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.
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-6779
Fax
(401) 444-6912
NPI assigned
May 22, 2012
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 DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Transplant Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204F00000X
Critical Care Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LC0200X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X
Pediatric Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0120X
Trauma Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0127X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
Surgical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086X0206X
Colon & Rectal Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208C00000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

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

1400 W Main Rd
Middletown, RI 02842
Phone (401) 606-4510

19 Friendship St
Apt 150160
Newport, RI 02840

19 Friendship St
#G130
Newport, RI 02840
Phone (401) 845-4311

19 Friendship St
Unit G40
Newport, RI 02840
Phone (401) 848-5556

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

17 Seekonk St
Providence, RI 02906
Phone (401) 453-3311

146 W River St
Ste 11D
Providence, RI 02904
Phone (401) 606-3000

148 W River St
Ste 8
Providence, RI 02904
Phone (401) 606-3000

208 Collyer St
Ste 301A
Providence, RI 02904
Phone (401) 725-4888

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

146 W River St
#11D
Providence, RI 02904

235 Plain St
Ste 203
Providence, RI 02905
Phone (401) 444-2701

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

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

501 Centerville Rd
Ste 101
Warwick, RI 02886
Phone (401) 606-2680

Practitioners & affiliated clinicians

Practitioners 1,735

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

View all 1,735

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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Transplant Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Trauma Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY 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.