{
"Npi": {
"NPI": "1083932438",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "FOOTPRINT PODIATRY CONSULTANTS, LLC",
"ParentOrgTIN": null,
"OrgName": "FOOTPRINT PODIATRY CONSULTANTS, 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": "4316 18TH ST NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WASHINGTON",
"MailingAddressStateName": "DC",
"MailingAddressPostalCode": "20011-4228",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-412-9664",
"MailingAddressFaxNumber": "202-525-2348",
"FirstLinePracticeLocationAddress": "1328 SOUTHERN AVE SE",
"SecondLinePracticeLocationAddress": "SUITE 209",
"PracticeLocationAddressCityName": "WASHINGTON",
"PracticeLocationAddressStateName": "DC",
"PracticeLocationAddressPostalCode": "20032-4689",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-506-1001",
"PracticeLocationAddressFaxNumber": "202-506-1008",
"EnumerationDate": "05/10/2010",
"LastUpdateDate": "08/02/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCRUGGS",
"AuthorizedOfficialFirstName": "MICHANGELO",
"AuthorizedOfficialMiddleName": "DARREN",
"AuthorizedOfficialTitle": "PODIATRIST/CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "202-506-1001",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP1100X",
"TaxonomyName": "Podiatric Clinic/Center",
"LicenseNumber": "PO1000031",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}