{
"Npi": {
"NPI": "1245460039",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BAY STATE MEDICAL, INC",
"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": "7271 PARK CIRCLE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HANOVER",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21076-1325",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-859-2366",
"MailingAddressFaxNumber": "410-859-3002",
"FirstLinePracticeLocationAddress": "23475 ROCK HAVEN WAY",
"SecondLinePracticeLocationAddress": "SUITE 120",
"PracticeLocationAddressCityName": "DULLES",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "20166-4444",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-643-0268",
"PracticeLocationAddressFaxNumber": "800-643-3577",
"EnumerationDate": "07/15/2009",
"LastUpdateDate": "10/17/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHAUB",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "410-859-2366",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BX2000X",
"TaxonomyName": "Oxygen Equipment & Supplies (DME)",
"LicenseNumber": "0206009130",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}