{
"Npi": {
"NPI": "1114372356",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JULES STEIN INSTITUTE MEDICAL GROUP",
"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": "622 W DUARTE RD",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "ARCADIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91007-7606",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "626-254-9010",
"MailingAddressFaxNumber": "262-254-9019",
"FirstLinePracticeLocationAddress": "5767 W CENTURY BLVD",
"SecondLinePracticeLocationAddress": "STE 400",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90045-5631",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-301-8707",
"PracticeLocationAddressFaxNumber": "310-301-8751",
"EnumerationDate": "04/25/2016",
"LastUpdateDate": "04/25/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONDINO",
"AuthorizedOfficialFirstName": "BARTLY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "CHAIRMAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "310-825-5053",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}