NPIMap

Organization Active NPI

Lifebridge Suburban Physician Group II, LLC

  • Pediatrics Physician
  • Lutherville, MD
National Provider Identifier
1851835136
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II, LLC
Practice address
12221 Tullamore Rd
Lutherville, MD 21093-7816
Phone
(410) 252-6790
NPI assigned
Dec 6, 2016
Organization subpart
Yes
Parent organization
LIFEBRIDGE COMMUNITY PHYSICIANS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Authorized official

Name
Mary R Wright-Sisk
Title
Director
Phone
(443) 422-9941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

12221 Tullamore Rd
Lutherville, MD 21093-7816

Mailing address

12221 Tullamore Rd
Lutherville, MD 21093-7816
Phone (410) 252-6790

Other names 1

  • Dr. Gaurav Kumar Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170316002018 MD Part B Supplier - Clinic/Group Practice 3173808045 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lutherville, MD; Baltimore, MD; Glen Burnie, MD

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Dr Gaurav Kumar7 organizations share this tax ID, including this one
Part of
Lifebridge Community Physicians Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630368000000",
    "number": "1851835136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 TULLAMORE RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210937816",
            "telephone_number": "410-252-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 TULLAMORE RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210937816",
            "telephone_number": "410-252-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC.",
        "enumeration_date": "2016-12-06",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-422-9941"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Gaurav Kumar",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Gaurav Kumar",
            "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 31, 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.