{
"Npi": {
"NPI": "1336797042",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRIGHTVIEW SENIOR HEALTH",
"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": "141 N PALMETTO AVE UNIT 602",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAGLE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83616-8025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-509-8987",
"MailingAddressFaxNumber": "208-225-6858",
"FirstLinePracticeLocationAddress": "1983 N SYNERGY PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAGLE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83616-7332",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-509-8987",
"PracticeLocationAddressFaxNumber": "208-225-6858",
"EnumerationDate": "08/27/2019",
"LastUpdateDate": "09/09/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YE-LIEW",
"AuthorizedOfficialFirstName": "LOUISE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DO, OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "208-509-8987",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}