{
"Npi": {
"NPI": "1346135225",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROSS",
"FirstName": "LELAND",
"MiddleName": "JA-REL OLLEN",
"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": "5094 OTT RD UNIT B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT SILL",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73503-3195",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-971-6883",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "602 SW 38TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAWTON",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73505-6912",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-250-2633",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/11/2025",
"LastUpdateDate": "06/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "X",
"Gender": null,
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171M00000X",
"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}