{
"Npi": {
"NPI": "1194284414",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LIM",
"FirstName": "MAFETH",
"MiddleName": "ARAULA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DO",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6810 STATE ROUTE 162",
"SecondLineMailingAddress": "BOX 215",
"MailingAddressCityName": "MARYVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62062",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-391-6495",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "531 VANDALIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLLINSVILLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62234-4061",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-344-0090",
"PracticeLocationAddressFaxNumber": "618-344-4371",
"EnumerationDate": "03/16/2019",
"LastUpdateDate": "08/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "2021020850",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}