{
"Npi": {
"NPI": "1194044792",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROMONTORY GERIATRICS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2727 BOLTON BOONE DR STE 114",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DESOTO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75115-2019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-857-3142",
"MailingAddressFaxNumber": "469-857-3077",
"FirstLinePracticeLocationAddress": "2727 BOLTON BOONE DR STE 114",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DESOTO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75115-2019",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-857-3142",
"PracticeLocationAddressFaxNumber": "469-857-3077",
"EnumerationDate": "05/20/2010",
"LastUpdateDate": "04/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIGHAM",
"AuthorizedOfficialFirstName": "GENE",
"AuthorizedOfficialMiddleName": "O",
"AuthorizedOfficialTitle": "MANAGING OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "469-857-3142",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "J6337",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207RG0300X",
"TaxonomyName": "Geriatric Medicine (Internal Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QH0002X",
"TaxonomyName": "Hospice and Palliative Medicine (Family Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}