{
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "WESTERN REHABILITATION AND PAIN MANAGEMENT, S.C.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 5978",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VILLA PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60181-5312",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-873-5425",
"MailingAddressFaxNumber": "630-620-1196",
"FirstLinePracticeLocationAddress": "2340 S HIGHLAND AVE",
"SecondLinePracticeLocationAddress": "SUITE 370",
"PracticeLocationAddressCityName": "LOMBARD",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-873-5425",
"PracticeLocationAddressFaxNumber": "630-620-1196",
"EnumerationDate": "05/24/2010",
"LastUpdateDate": "11/18/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIDDIQUI",
"AuthorizedOfficialFirstName": "MOHAMMED",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "630-873-5425",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": "036082891",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}