{
"Npi": {
"NPI": "1184975948",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "1.JILL FURGURSON, M.D., 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": "23941 DE VILLE WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MALIBU",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90265-4894",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-710-7761",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "23656 PACIFIC COAST HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MALIBU",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90265-4800",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-456-7551",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/19/2012",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FURGURSON",
"AuthorizedOfficialFirstName": "JILL",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "818-710-7761",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "G36815",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}