{
"Npi": {
"NPI": "1104731470",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLUEPRINT HEALTHCARE MEDICAL GROUP PAIN MANAGEMENT",
"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": "93 MILL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLETON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01949-1008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-779-5939",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "94 SUMMER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FITCHBURG",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01420-5761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-779-5939",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/18/2026",
"LastUpdateDate": "08/18/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAJEKODUNMI",
"AuthorizedOfficialFirstName": "AKINDELE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "267-779-5939",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain 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."
}
}
}
}