{
"Npi": {
"NPI": "1124207865",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREGORY M BRACCIA MD 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": "PO BOX 546",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYNE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19087-0546",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "484-452-8003",
"MailingAddressFaxNumber": "610-879-5129",
"FirstLinePracticeLocationAddress": "945 CHESTERBROOK BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHESTERBROOK",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19087-5614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-695-8088",
"PracticeLocationAddressFaxNumber": "610-695-6356",
"EnumerationDate": "10/30/2007",
"LastUpdateDate": "12/06/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCARDUZIO",
"AuthorizedOfficialFirstName": "BERNADETTE",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "BILLING MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "484-452-8003",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain Medicine Physician",
"LicenseNumber": "MD0489261",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}