{
"Npi": {
"NPI": "1417430307",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PR HEALTHCARE MANAGEMENT GROUP",
"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": "PO BOX 2598",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GUAYNABO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00970-2598",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-874-1825",
"MailingAddressFaxNumber": "787-874-3125",
"FirstLinePracticeLocationAddress": "PR31 KM 4.0",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NAGUABO",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00718",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-874-1825",
"PracticeLocationAddressFaxNumber": "787-874-3125",
"EnumerationDate": "09/07/2018",
"LastUpdateDate": "09/07/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEGRON JUDICE",
"AuthorizedOfficialFirstName": "HARRY",
"AuthorizedOfficialMiddleName": "EMILIO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "787-874-1825",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "32",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "32",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}