{
"Npi": {
"NPI": "1295077188",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPEED IMAGING LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1263 S HIGHLAND AVE STE 2D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOMBARD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60148-4527",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-814-9911",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1263 S HIGHLAND AVE STE 2D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOMBARD",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60148-4527",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-814-9911",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/19/2013",
"LastUpdateDate": "04/05/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ASHFAQ",
"AuthorizedOfficialFirstName": "MOHAMMED",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "MR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-656-1455",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2471N0900X",
"TaxonomyName": "Nuclear Medicine Technology Radiologic Technologist",
"LicenseNumber": "034872",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2471S1302X",
"TaxonomyName": "Sonography Radiologic Technologist",
"LicenseNumber": "111990",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246XS1301X",
"TaxonomyName": "Sonography Specialist/Technologist Cardiovascular",
"LicenseNumber": "111990",
"LicenseNumberStateCode": "IL",
"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."
},
{
"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."
},
{
"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."
}
]
}
}
}