{
"Npi": {
"NPI": "1295407948",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CARE COORDINATION SERVICES OF ALASKA 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": "PO BOX 671403",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHUGIAK",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99567-1403",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-301-0072",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24937 JESSE LEE COURT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHUGIAK",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99567",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "190-730-1007",
"PracticeLocationAddressFaxNumber": "822-409-2220",
"EnumerationDate": "10/01/2021",
"LastUpdateDate": "07/28/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER / ADMIISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "907-301-0072",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}