{
"Npi": {
"NPI": "1104621358",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LUXMED LLC",
"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": "30 N GOULD ST STE N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHERIDAN",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82801-6317",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-283-9801",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15 BRENDAN WAY STE 210",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENVILLE",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29615-3562",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-305-5000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/13/2025",
"LastUpdateDate": "02/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRANCATI",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "419-283-9801",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}