{
"Npi": {
"NPI": "1306358668",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RSS GARY NELSON LLC",
"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": "1050 TEXAN TRL STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAPEVINE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76051-3759",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-440-6060",
"MailingAddressFaxNumber": "469-533-0476",
"FirstLinePracticeLocationAddress": "11912 JONES BRIDGE RD STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALPHARETTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30005-4613",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-859-2525",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/26/2017",
"LastUpdateDate": "10/26/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROWN",
"AuthorizedOfficialFirstName": "SARA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-440-6060",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QS1200X",
"TaxonomyName": "Sleep Disorder Diagnostic Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}