{
"Npi": {
"NPI": "1053134916",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RESTORATIVE HEALTH SOLUTIONS",
"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": "4829 INDEPENDENCE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT REPUBLIC",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20676-2053",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-422-0738",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4829 INDEPENDENCE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORT REPUBLIC",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20676-2053",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-422-0738",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/07/2024",
"LastUpdateDate": "11/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AFRIYIE",
"AuthorizedOfficialFirstName": "PIUS",
"AuthorizedOfficialMiddleName": "OWUSU",
"AuthorizedOfficialTitle": "PHYSICIAN ASSISTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PA-C",
"AuthorizedOfficialTelephoneNumber": "443-422-0738",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}