{
"Npi": {
"NPI": "1295651172",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDSTAR PAIN PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "391 LAS COLINAS BLVD E # 130-550",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRVING",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75039-6291",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8585 N STEMMONS FWY STE S-106",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DALLAS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75247-3836",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-502-4772",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/25/2026",
"LastUpdateDate": "06/25/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GODINEZ",
"AuthorizedOfficialFirstName": "CARAH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-705-6517",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}