LIFESPAN PHYSICIAN GROUP, INC.
Complete NPI Record 1548506793
Psychiatry & Neurology - Psychiatry in Providence, RI
Active since December 17, 2012
Complete NPI Dataset
This page contains the complete raw NPPES record for Lifespan Physician Group, Inc. (NPI 1548506793), a psychiatry & neurology organization in Providence, RI. All 64 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1548506793 Field 1/64
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/64
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/64
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: LIFESPAN PHYSICIAN GROUP, INC. Field 4/64
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/64
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/64
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 15 LA SALLE SQ Field 7/64
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: PROVIDENCE Field 8/64
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: RI Field 9/64
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 029031814 Field 10/64
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/64
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4014446779 Field 12/64
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 4014446912 Field 13/64
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 593 EDDY STREET Field 14/64
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: PROVIDENCE Field 15/64
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: RI Field 16/64
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 02903 Field 17/64
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/64
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4014447442 Field 19/64
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: MARKELL Field 22/64
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: PETER Field 23/64
- The first name of the authorized official.
- Authorized Official Middle Name: K Field 24/64
- The middle name of the authorized official.
- Authorized Official Title or Position: EVP & CFO Field 25/64
- The title or position of the authorized official.
- Authorized Official Telephone Number: 4014447914 Field 26/64
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 1041C0700X Field 27/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 103G00000X Field 29/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 30/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 2084B0040X Field 31/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 32/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 103TC0700X Field 33/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 34/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 5: 363LP0808X Field 35/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 5: N Field 36/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 6: 103TC2200X Field 37/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 6: N Field 38/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 7: 2084N0600X Field 39/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 7: N Field 40/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 8: 2084P0804X Field 41/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 8: N Field 42/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 9: 103T00000X Field 43/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 9: N Field 44/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 10: 2084N0400X Field 45/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 10: N Field 46/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 11: 2084P0800X Field 47/64
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 11: Y Field 48/64
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 49/64
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: LIFESPAN CORPORATION Field 50/64
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 51/64
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
- Authorized Official Name Prefix Text: MR. Field 52/64
- The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 53/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 54/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 55/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP Field 56/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP Field 57/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP Field 58/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP Field 59/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP Field 60/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP Field 61/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP Field 62/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP Field 63/64
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Brown Health Medical Group Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 9
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
146 W River St
Location 1/9Providence, RI 02904-2609 · Phone (401) 444-7442 · Fax (401) 444-7109
1011 Veterans Memorial Pkwy
Location 2/9Riverside, RI 02915-5061 · Phone (401) 432-1000
1 Hoppin St
Location 3/9Providence, RI 02903-4141 · Phone (401) 444-8945 · Fax (401) 444-8742
1567 S County Trl
Location 4/9East Greenwich, RI 02818-1695 · Phone (401) 606-3137
200 Corliss St
Location 5/9Providence, RI 02904-2602 · Phone (401) 606-8530
167 Point St
Location 6/9Providence, RI 02903-4771 · Phone (401) 793-8808
164 Summit Ave
Location 7/9Providence, RI 02906-2853 · Phone (401) 793-2500
19 Friendship St
Location 8/9Newport, RI 02840-2272 · Phone (401) 845-4340 · Fax (401) 845-4349
1454 S County Trl
Location 9/9East Greenwich, RI 02818-1749 · Phone (401) 606-4415
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