{
"Npi": {
"NPI": "1366834640",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DORN MEDICAL GROUP, P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "220 LAKE ESTATE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHAPIN",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29036-7789",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "121 BLYTHEWOOD RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLYTHEWOOD",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29016-8426",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-606-8935",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/24/2015",
"LastUpdateDate": "02/24/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DORN",
"AuthorizedOfficialFirstName": "FRANK",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "CHIEF MEDICAL OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PA-C",
"AuthorizedOfficialTelephoneNumber": "803-606-8935",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "PA05553",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}