{
"Npi": {
"NPI": "1427717115",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ROCK RIVER COMMUNITY CLINIC INC",
"ParentOrgTIN": null,
"OrgName": "ROCK RIVER COMMUNITY CLINIC 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": "1461 W MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WHITEWATER",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53190-1568",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-472-6839",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "132 HOSPITAL DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WATERTOWN",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53098-3304",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-206-7797",
"PracticeLocationAddressFaxNumber": "920-206-0870",
"EnumerationDate": "12/10/2021",
"LastUpdateDate": "06/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICHOLS",
"AuthorizedOfficialFirstName": "OLIVIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "262-472-6839",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QC1500X",
"TaxonomyName": "Community Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}