{
"Npi": {
"NPI": "1376949263",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHOICES, INC",
"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": "4701 N KEYSTONE AVE",
"SecondLineMailingAddress": "SUITE 150",
"MailingAddressCityName": "INDIANAPOLIS",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46205-1554",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-726-2121",
"MailingAddressFaxNumber": "317-726-2130",
"FirstLinePracticeLocationAddress": "300 TALBOT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EASTON",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21601-3525",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "877-565-5392",
"PracticeLocationAddressFaxNumber": "866-397-3531",
"EnumerationDate": "11/05/2014",
"LastUpdateDate": "11/05/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDBERG",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS",
"AuthorizedOfficialTelephoneNumber": "317-726-2121",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}