{
"Npi": {
"NPI": "1053595850",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COUNTRY DOCTOR MEDICAL SERVICES, INC.",
"ParentOrgTIN": null,
"OrgName": "COUNTRY DOCTOR MEDICAL SERVICES, INC",
"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": "932 MARLIN CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JUPITER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33458-4306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-743-2342",
"MailingAddressFaxNumber": "866-896-2367",
"FirstLinePracticeLocationAddress": "11381 PROSPERITY FARMS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALM BEACH GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33410-3403",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-743-2342",
"PracticeLocationAddressFaxNumber": "800-896-2367",
"EnumerationDate": "12/28/2007",
"LastUpdateDate": "10/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PLATT",
"AuthorizedOfficialFirstName": "HAMILTON",
"AuthorizedOfficialMiddleName": "CARL",
"AuthorizedOfficialTitle": "OWNER, PRESIDENT, CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "561-743-2342",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "ME59301",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}