{
"Npi": {
"NPI": "1164607040",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SE RADIOLOGY ASSOCIATES, PC",
"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": "4000 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYNE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48184-1715",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-326-5030",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4491 VENOY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYNE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48184-2530",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-326-5030",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "06/12/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAIN",
"AuthorizedOfficialFirstName": "ASHOK",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "734-326-5030",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}