{
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"FirstLineMailingAddress": "999 SIXTH ST",
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"MailingAddressCityName": "TRAVERSE CITY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49684-2301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "231-941-4114",
"MailingAddressFaxNumber": "231-941-0878",
"FirstLinePracticeLocationAddress": "999 SIXTH ST",
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"PracticeLocationAddressCityName": "TRAVERSE CITY",
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"PracticeLocationAddressFaxNumber": "231-941-0878",
"EnumerationDate": "01/06/2009",
"LastUpdateDate": "01/06/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMONS",
"AuthorizedOfficialFirstName": "JAMES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "231-941-4114",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}