NPIMap

Organization Active NPI

Lifebridge Community Physicians, Inc

  • Family Medicine Physician
  • Randallstown, MD
National Provider Identifier
1588093652
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Practice address
5400 Old Court Rd Ste 300B
Randallstown, MD 21133-5126
Phone
(410) 521-7337
Fax
(410) 521-7377
NPI assigned
Nov 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Authorized official

Name
Mary Wright-Sisk, M.D.
Title
Director
Phone
(443) 422-9941

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

5400 Old Court Rd Ste 300B
Randallstown, MD 21133-5126

Mailing address

5400 Old Court Rd Ste 300B
Randallstown, MD 21133-5126
Phone (410) 521-7337

Other names 1

  • Potomac Professionals Other name

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2149588LBH Potomac Professionals LLC - Randallstown5400 Old Court Rd Suite 300B, Randallstown, MD 21133Certificate of waiverJun 6, 2028

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772668800000",
    "number": "1588093652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 OLD COURT RD STE 300B",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335126",
            "telephone_number": "410-521-7337",
            "fax_number": "410-521-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 OLD COURT RD STE 300B",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335126",
            "telephone_number": "410-521-7337",
            "fax_number": "410-521-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-08",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-422-9941",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potomac Professionals",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.