NPIMap

Organization Active NPI

Lifebridge Multi-Specialty, LLC

  • Family Medicine Physician
  • Westminster, MD
National Provider Identifier
1972978625
Registry record updated Dec 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LIFEBRIDGE MULTI-SPECIALTY, LLC
Practice address
41 Magna Way
Suite 100
Westminster, MD 21157-3073
Phone
(410) 751-6684
Fax
(410) 751-2371
NPI assigned
Dec 7, 2015
Last updated
Dec 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2015

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

Authorized official

Name
Ms. Mary R Wright-Sisk
Title
Director
Phone
(410) 701-4439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

41 Magna Way
Suite 100
Westminster, MD 21157-3073

Mailing address

41 Magna Way
Suite 100
Westminster, MD 21157-3073
Phone (410) 751-6684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160203001931 MD Part B Supplier - Clinic/Group Practice 1153625660 Receives reassigned benefits from 5 practitioners
Practice locations: Westminster, MD

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

41 Magna Way
Ste 100
Westminster, MD 21157
Phone (410) 751-6684

Practitioners & affiliated clinicians

Practitioners 6

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": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449446400000",
    "number": "1972978625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MAGNA WAY",
            "address_2": "SUITE 100",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211573073",
            "telephone_number": "410-751-6684",
            "fax_number": "410-751-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 MAGNA WAY",
            "address_2": "SUITE 100",
            "city": "WESTMINSTER",
            "state": "MD",
            "postal_code": "211573073",
            "telephone_number": "410-751-6684",
            "fax_number": "410-751-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE MULTI-SPECIALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2015-12-07",
        "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": "410-701-4439",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.