{
"Npi": {
"NPI": "1104253111",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIMARY CARE PHYSICIAN NETWORK P C",
"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": "2843 E GRAND RIVER AVE",
"SecondLineMailingAddress": "BOX 260",
"MailingAddressCityName": "EAST LANSING",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48823-6722",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-206-1388",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4136 LEGACY PKWY",
"SecondLinePracticeLocationAddress": "SUITE 110",
"PracticeLocationAddressCityName": "LANSING",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48911-4265",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-206-1388",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/04/2013",
"LastUpdateDate": "10/04/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BASHIR",
"AuthorizedOfficialFirstName": "ASHER",
"AuthorizedOfficialMiddleName": "JAVAID",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "J.D.",
"AuthorizedOfficialTelephoneNumber": "517-206-1388",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}