NPIMap

Organization Active NPI

Lifebridge Community Physicians, Inc.

  • Internal Medicine Physician
  • Randallstown, MD
National Provider Identifier
1912364076
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Practice address
8600 Liberty Rd
Randallstown, MD 21133-4707
Phone
(410) 521-4211
Fax
(410) 521-0627
NPI assigned
Jan 20, 2016
Last updated
Aug 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

8600 Liberty Rd
Randallstown, MD 21133-4707

Mailing address

8600 Liberty Rd
Randallstown, MD 21133-4707
Phone (410) 521-4211

Other names 1

  • LifeBridge Health Primary Care at Liberty Road 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

National Provider Directory

National Provider Directory
Tax ID family
Lifebridge Community Physicians148 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

913 Ridgebrook Rd
Ste 312
Sparks Glencoe, MD 21152
Phone (410) 472-6560

Practitioners & affiliated clinicians

Practitioners 9

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": "1453248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1912364076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 LIBERTY RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334707",
            "telephone_number": "410-521-4211",
            "fax_number": "410-521-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 LIBERTY RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334707",
            "telephone_number": "410-521-4211",
            "fax_number": "410-521-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-20",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBridge Health Primary Care at Liberty Road",
            "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 Aug 21, 2024; 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.