{
"Npi": {
"NPI": "1104024397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOHN M FAGGARD III, MD",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1005 HIGHWAY 2 W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANDPOINT",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83864-1702",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-265-5916",
"MailingAddressFaxNumber": "208-255-2066",
"FirstLinePracticeLocationAddress": "1005 HIGHWAY 2 W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANDPOINT",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83864-1702",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-265-5916",
"PracticeLocationAddressFaxNumber": "208-255-2066",
"EnumerationDate": "07/10/2007",
"LastUpdateDate": "04/09/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAGGARD",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "208-265-5916",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "M6916",
"LicenseNumberStateCode": "ID",
"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."
}
}
}
}