{
"Npi": {
"NPI": "1013389840",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEARL PODIATRY HEALTH CENTER, LLC",
"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": "27087 GRATIOT AVE",
"SecondLineMailingAddress": "2ND FLOOR",
"MailingAddressCityName": "ROSEVILLE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48066-2947",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-498-9440",
"MailingAddressFaxNumber": "586-498-9460",
"FirstLinePracticeLocationAddress": "2575 PEARL ST",
"SecondLinePracticeLocationAddress": "SUITE #240",
"PracticeLocationAddressCityName": "BOULDER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80302-3868",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-442-2910",
"PracticeLocationAddressFaxNumber": "303-442-2931",
"EnumerationDate": "10/20/2015",
"LastUpdateDate": "10/20/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACHIMIAK",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "303-442-2910",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}