{
"Npi": {
"NPI": "1235880766",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ON THE MARK PSYCHIATRIC SERVICES, 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": "216 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHMOND",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23219-3715",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "804-878-3518",
"MailingAddressFaxNumber": "651-855-5083",
"FirstLinePracticeLocationAddress": "216 E MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RICHMOND",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23219-3715",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "804-878-3518",
"PracticeLocationAddressFaxNumber": "651-855-5083",
"EnumerationDate": "01/17/2022",
"LastUpdateDate": "03/02/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRAXTON",
"AuthorizedOfficialFirstName": "HANNAH",
"AuthorizedOfficialMiddleName": "MARKS",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "804-878-3518",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry 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."
}
}
}
}