NPIMap

Organization Active NPI

Lifebridge Community Physicians, Inc

Doing business as Drs Gouel, Blotny and Sullivan

  • Pediatrics Physician
  • Lutherville, MD
National Provider Identifier
1831457563
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Doing business as
Drs Gouel, Blotny and Sullivan
Practice address
1205 York Rd
Suite 18
Lutherville, MD 21093-6210
Phone
(410) 583-6800
Fax
(410) 583-5259
NPI assigned
May 1, 2012
Last updated
Aug 27, 2021By the provider in NPPES
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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X MD Primary

Addresses

Primary practice location

1205 York Rd
Suite 18
Lutherville, MD 21093-6210

Mailing address

1205 York Rd
Suite 18
Lutherville, MD 21093-6210
Phone (410) 583-6800

Other names 1

  • Drs Gouel, Blotny and Sullivan 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 Phyinc148 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

Locations

602 S Atwood Rd
Ste 100
Bel Air, MD 21014
Phone (410) 638-9950

1205 York Rd
Ste 18
Lutherville Timonium, MD 21093
Phone (410) 494-0191

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1831457563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 YORK RD",
            "address_2": "SUITE 18",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936210",
            "telephone_number": "410-583-6800",
            "fax_number": "410-583-5259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 YORK RD",
            "address_2": "SUITE 18",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936210",
            "telephone_number": "410-583-6800",
            "fax_number": "410-583-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "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": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs Gouel, Blotny and Sullivan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Drs Gouel, Blotny and Sullivan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lutherville, 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.