{
"Npi": {
"NPI": "1225058266",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PHILLIPS",
"FirstName": "LARRY",
"MiddleName": "C.",
"NamePrefix": null,
"NameSuffix": "II",
"Credential": "P.A.C.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "441 E PINEY FOREST RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24540",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-791-4110",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "441 E PINEY FOREST RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DANVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-791-4110",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/20/2006",
"LastUpdateDate": "05/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "102445",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "0110003402",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}