{
"Npi": {
"NPI": "1265991038",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HENDRICKSON",
"FirstName": "PETER",
"MiddleName": "GEORGE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD, PHD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3200 BURNET AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CINCINNATI",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45229-3019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3151 BELLEVUE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CINCINNATI",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45219-2370",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-584-3494",
"PracticeLocationAddressFaxNumber": "513-584-4007",
"EnumerationDate": "03/19/2019",
"LastUpdateDate": "10/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2085R0001X",
"TaxonomyName": "Radiation Oncology Physician",
"LicenseNumber": "2024-01280",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0001X",
"TaxonomyName": "Radiation Oncology Physician",
"LicenseNumber": "35.154296",
"LicenseNumberStateCode": "OH",
"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."
}
}
}
}