Lifebridge Community Physicians Inc

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

LIFEBRIDGE COMMUNITY PHYSICIANS INC

Doing business as

LifeBridge Suburban Physicians group, Llc D/B/A Dr. Russell Schub

Practice address

8875 Centre Park Dr Ste D
Columbia, MD 21045-2382

Phone

(410) 489-3020

NPI assigned

Sep 29, 2020

Last updated

Sep 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Rebecca Wright-Sisk

Title

Director

Phone

(410) 701-4439

Specialties & licenses 1

Addresses

Other names 1

• LifeBridge Suburban Physicians group, Llc D/B/A Dr. Russell Schub Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 8

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.

• Gayle Marie Blum, PMHNP-BC. FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Boring, MD
  • NPI 1568982940
  NPD
• Erica Gaertner, M.D.

  • Sports Medicine (Internal Medicine) Physician
  • Owings Mills, MD
  • NPI 1124478755
  NPD
• Amber Phelps

  • Adult Health Nurse Practitioner
  • Eldersburg, MD
  • NPI 1639760382
  NPD
• Kathleen Scott, PA-C

  • Physician Assistant
  • Randallstown, MD
  • NPI 1457724676
  NPD
• Robert John Stephens, MD

  • Emergency Medicine Physician
  • Baltimore, MD
  • NPI 1811557028
  NPD
• Christina Vrettakos

  • Pediatrics Physician
  • Bel Air, MD
  • NPI 1235715616
  NPD
• Farhan Ali, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Tampa, FL
  • NPI 1629225529
  NPD
• Henry Ostman

  • Pulmonary Disease Physician
  • Lemoyne, PA
  • NPI 1851516504
  NPD

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1477160984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8875 CENTRE PARK DR STE D",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8875 CENTRE PARK DR STE D",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452382",
            "telephone_number": "410-489-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "REBECCA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "410-701-4439"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBridge Suburban Physicians group, Llc D/B/A Dr. Russell Schub",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gastroenterology Physician in Columbia, MD
• Providers in Columbia, MD by specialty
• Gastroenterology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.