{
"Npi": {
"NPI": "1174548945",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JONES",
"FirstName": "SAMUEL",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": "II",
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JONES",
"OtherFirstName": "SAMUEL",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "543 W 141ST ST",
"SecondLineMailingAddress": "GROUND FLOOR APTMT",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10031-7026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-447-4922",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24 HOSPITAL AVE",
"SecondLinePracticeLocationAddress": "DANBURY HOSPITAL",
"PracticeLocationAddressCityName": "DANBURY",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-739-7000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/13/2006",
"LastUpdateDate": "10/01/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207P00000X",
"TaxonomyName": "Emergency Medicine Physician",
"LicenseNumber": "84031",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207P00000X",
"TaxonomyName": "Emergency Medicine Physician",
"LicenseNumber": "217144",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207P00000X",
"TaxonomyName": "Emergency Medicine Physician",
"LicenseNumber": "53539",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}