{
"Npi": {
"NPI": "1104220573",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAVALIER JOY & CROWN PEDIATRIC SPECIALISTS, PLLC",
"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": "PO BOX 6023",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRISCO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75035-0226",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-213-7634",
"MailingAddressFaxNumber": "469-535-3664",
"FirstLinePracticeLocationAddress": "7002 LEBANON RD",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "FRISCO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75034-7461",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-213-7633",
"PracticeLocationAddressFaxNumber": "469-535-3664",
"EnumerationDate": "10/14/2014",
"LastUpdateDate": "12/26/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAVALIER",
"AuthorizedOfficialFirstName": "MARYELLEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "469-213-7634",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QI0500X",
"TaxonomyName": "Infusion Therapy Clinic/Center",
"LicenseNumber": "M9913",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "M9913",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "M9913",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}