{
"Npi": {
"NPI": "1023562279",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STAY HOME I WILL, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11201 SANDUSKY ST STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PERRYSBURG",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43551-3130",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-214-1213",
"MailingAddressFaxNumber": "419-214-0783",
"FirstLinePracticeLocationAddress": "11201 SANDUSKY ST STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PERRYSBURG",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43551-3130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-214-1213",
"PracticeLocationAddressFaxNumber": "419-214-0783",
"EnumerationDate": "08/04/2016",
"LastUpdateDate": "01/09/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOKULA",
"AuthorizedOfficialFirstName": "RADHARAMANAMURTHY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD,CMD,DIPABLM",
"AuthorizedOfficialTelephoneNumber": "419-214-1213",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "35-089833",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}