{
"Npi": {
"NPI": "1417688078",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SANJIV MIDHA MD A MEDICAL CORPORATION A PROFESSIONAL CORPORATION",
"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": "1215 PLUMAS ST STE 500",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YUBA CITY",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95991-3453",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "530-898-1201",
"MailingAddressFaxNumber": "530-898-1204",
"FirstLinePracticeLocationAddress": "50 EAST GRIDLEY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRIDLEY",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95948",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "530-674-2100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2022",
"LastUpdateDate": "09/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIDHA",
"AuthorizedOfficialFirstName": "SANJIV",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "530-674-2100",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}