{
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"NamePrefix": null,
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"FirstLineMailingAddress": "4821 BRIAR ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLEVELAND",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44135-5039",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "216-362-1422",
"MailingAddressFaxNumber": "216-362-1426",
"FirstLinePracticeLocationAddress": "4821 BRIAR ROAD",
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"PracticeLocationAddressCityName": "CLEVELAND",
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"EnumerationDate": "05/07/2008",
"LastUpdateDate": "05/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTHEI",
"AuthorizedOfficialFirstName": "WALLACE",
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"AuthorizedOfficialTelephoneNumber": "216-362-1422",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}