{
"Npi": {
"NPI": "1124488408",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHESAPEAKE FAMILY PRACTICE, INC.",
"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": "1201 PEMBERTON DR STE 2A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALISBURY",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21801-2501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-978-7170",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1201 PEMBERTON DR STE 2A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALISBURY",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21801-2501",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-978-7170",
"PracticeLocationAddressFaxNumber": "443-978-7173",
"EnumerationDate": "03/01/2016",
"LastUpdateDate": "07/26/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HILL",
"AuthorizedOfficialFirstName": "JESSICA",
"AuthorizedOfficialMiddleName": "LEIGH",
"AuthorizedOfficialTitle": "CEO/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CRNP",
"AuthorizedOfficialTelephoneNumber": "410-251-6246",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "R181859",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "R181859",
"LicenseNumberStateCode": "MD",
"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."
}
}
}
}