{
"Npi": {
"NPI": "1275248403",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LIPSCOMB",
"FirstName": "ELI",
"MiddleName": "RAINIER",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "304 N RIOS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOLANA BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92075-1242",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "858-204-5792",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4002 VISTA WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCEANSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92056-4506",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-940-7701",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2023",
"LastUpdateDate": "01/23/2023",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "95020598",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}