{
"Npi": {
"NPI": "1417222076",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SURGICAL ASSOCIATES OF KENOSHA, SC",
"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": "7600 2ND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENOSHA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53143-6067",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-652-5370",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6308 8TH AVE STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENOSHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53143-5031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-656-8217",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/15/2012",
"LastUpdateDate": "03/15/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PACANOWSKI",
"AuthorizedOfficialFirstName": "ROGER",
"AuthorizedOfficialMiddleName": "T.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M. D.",
"AuthorizedOfficialTelephoneNumber": "262-652-5370",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "16095",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}