{
"Npi": {
"NPI": "1306876362",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOETZ",
"FirstName": "THOMAS",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1771",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KEARNEY",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68848-1771",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "308-236-5506",
"MailingAddressFaxNumber": "308-236-7089",
"FirstLinePracticeLocationAddress": "115 E 52ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KEARNEY",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68847-0502",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "308-236-5506",
"PracticeLocationAddressFaxNumber": "308-236-7089",
"EnumerationDate": "07/04/2006",
"LastUpdateDate": "01/11/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "100682",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}