{
"Npi": {
"NPI": "1053743088",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "IBARRA",
"FirstName": "SUMMER",
"MiddleName": "L",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PH.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10293 N MERIDIAN ST",
"SecondLineMailingAddress": "STE 210",
"MailingAddressCityName": "CARMEL",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46290-1079",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-581-2292",
"MailingAddressFaxNumber": "317-581-2285",
"FirstLinePracticeLocationAddress": "5230 E STOP 11 RD STE 350",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "INDIANAPOLIS",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46237-6402",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-783-8383",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/01/2013",
"LastUpdateDate": "11/09/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103G00000X",
"TaxonomyName": "Clinical Neuropsychologist",
"LicenseNumber": "20042730A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TR0400X",
"TaxonomyName": "Rehabilitation Psychologist",
"LicenseNumber": "99058381A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TR0400X",
"TaxonomyName": "Rehabilitation Psychologist",
"LicenseNumber": "20042730A",
"LicenseNumberStateCode": "IN",
"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."
}
}
}
}