{
"Npi": {
"NPI": "1376076620",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BACK TO WORK ORTHOPEDIC MEDICAL GROUP",
"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": "7300 ALONDRA BLVD",
"SecondLineMailingAddress": "STE 101",
"MailingAddressCityName": "PARAMOUNT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90723-4000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "562-531-8300",
"MailingAddressFaxNumber": "562-531-8035",
"FirstLinePracticeLocationAddress": "7300 ALONDRA BLVD",
"SecondLinePracticeLocationAddress": "STE 100",
"PracticeLocationAddressCityName": "PARAMOUNT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90723-4000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "562-616-1166",
"PracticeLocationAddressFaxNumber": "562-616-1141",
"EnumerationDate": "04/04/2017",
"LastUpdateDate": "04/04/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MD",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "562-616-1166",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}