{
"Npi": {
"NPI": "1003248378",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BREAK4HEALTH",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "401 HUEHL RD",
"SecondLineMailingAddress": "2A",
"MailingAddressCityName": "NORTHBROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60062-2300",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-513-7905",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1535 LAKE COOK RD",
"SecondLinePracticeLocationAddress": "#112",
"PracticeLocationAddressCityName": "NORTHBROOK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60062-1447",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "224-235-4758",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/08/2013",
"LastUpdateDate": "08/08/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANDELL",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-309-7698",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "2137912",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}