{
"Npi": {
"NPI": "1306644190",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOSPITALIST MEDICINE PHYSICIANS OF MARYLAND PC",
"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": "120 BRENTWOOD COMMONS WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRENTWOOD",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37027-2023",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-682-6040",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1920 ROSEMONT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21702-8249",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "240-772-9200",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/06/2025",
"LastUpdateDate": "03/06/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FALL",
"AuthorizedOfficialFirstName": "LAURA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PAYER ENROLLMENT MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "253-682-6040",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"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."
},
{
"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."
}
]
}
}
}