{
"Npi": {
"NPI": "1174069371",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "JENNIFER BECK M.D.",
"ParentOrgTIN": null,
"OrgName": "WELLMIND CENTER, A MEDICAL CORPORATION",
"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": "1400 N. DUTTON AVENUE",
"SecondLineMailingAddress": "SUITE #6",
"MailingAddressCityName": "SANTA ROSA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95401-4644",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-566-9355",
"MailingAddressFaxNumber": "707-566-4644",
"FirstLinePracticeLocationAddress": "1400 N. DUTTON AVENUE",
"SecondLinePracticeLocationAddress": "SUITE #6",
"PracticeLocationAddressCityName": "SANTA ROSA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95401-4644",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-566-9355",
"PracticeLocationAddressFaxNumber": "707-566-4644",
"EnumerationDate": "01/11/2017",
"LastUpdateDate": "01/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEVER",
"AuthorizedOfficialFirstName": "ANTHONY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRACTICE MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "707-327-6000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry 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."
}
}
}
}