{
"Npi": {
"NPI": "1245709807",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CONNECTED MEDICAL GROUP 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": "617 W 1475 N",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OREM",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84057-2505",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-319-6102",
"MailingAddressFaxNumber": "385-900-1668",
"FirstLinePracticeLocationAddress": "724 S 1600 W STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MAPLETON",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84664-4347",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "385-498-0102",
"PracticeLocationAddressFaxNumber": "385-900-1668",
"EnumerationDate": "11/13/2018",
"LastUpdateDate": "01/05/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROOKS",
"AuthorizedOfficialFirstName": "AUBRIE",
"AuthorizedOfficialMiddleName": "E.W.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "385-498-0102",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}