{
"Npi": {
"NPI": "1215972567",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KEVIN KIMM DO,PC",
"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": "621 S ILLINOIS AVE",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "MASON CITY",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50401-5489",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "641-494-3041",
"MailingAddressFaxNumber": "641-494-3059",
"FirstLinePracticeLocationAddress": "1010 S GRAND AVE",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "CHARLES CITY",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50616-3729",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "641-228-5555",
"PracticeLocationAddressFaxNumber": "641-228-5556",
"EnumerationDate": "06/19/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIMM",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "641-228-5555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}