{
"Npi": {
"NPI": "1184883555",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH COUNTRY FAMILY MEDICINE PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "445 FACTORY ST",
"SecondLineMailingAddress": "PO BOX 91",
"MailingAddressCityName": "WATERTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13601-2729",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-782-4207",
"MailingAddressFaxNumber": "315-782-8699",
"FirstLinePracticeLocationAddress": "428 WASHINGTON ST",
"SecondLinePracticeLocationAddress": "STE 4",
"PracticeLocationAddressCityName": "WATERTOWN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13601-4832",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-788-4880",
"PracticeLocationAddressFaxNumber": "315-788-4896",
"EnumerationDate": "06/02/2008",
"LastUpdateDate": "03/31/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EMERTON",
"AuthorizedOfficialFirstName": "JON",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER/DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "315-788-4880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "227318",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}