{
"Npi": {
"NPI": "1225548753",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF",
"ParentOrgTIN": null,
"OrgName": "ST ELIZABETHS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER",
"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": "3051 HOLLIS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62704-7450",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-650-7474",
"MailingAddressFaxNumber": "618-222-4660",
"FirstLinePracticeLocationAddress": "791 WALL ST STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "O FALLON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62269-2087",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "866-650-4660",
"PracticeLocationAddressFaxNumber": "618-222-4660",
"EnumerationDate": "10/11/2017",
"LastUpdateDate": "01/21/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOND",
"AuthorizedOfficialFirstName": "ANN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SYSTEM DIRECTOR-GOVERNMENT REIMB",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "217-814-4586",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS1200X",
"TaxonomyName": "Sleep Disorder Diagnostic Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}