{
"Npi": {
"NPI": "1215983770",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DPMWOLERYPROH LLC",
"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": "818 GAY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTSMOUTH",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45662-4119",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-355-3095",
"MailingAddressFaxNumber": "740-355-3935",
"FirstLinePracticeLocationAddress": "818 GAY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTSMOUTH",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45662-4119",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-355-3095",
"PracticeLocationAddressFaxNumber": "740-355-3935",
"EnumerationDate": "05/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOLERY",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "740-355-3095",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213EP1101X",
"TaxonomyName": "Primary Podiatric Medicine Podiatrist",
"LicenseNumber": "36.001607",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}