{
"Npi": {
"NPI": "1437794492",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COMMUNITY HEALTH CLINIC, INC.",
"ParentOrgTIN": null,
"OrgName": "COMMUNITY HEALTH CLINIC, INC.",
"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": "943 FOURTH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW KENSINGTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15068-6409",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-889-2779",
"MailingAddressFaxNumber": "724-335-2283",
"FirstLinePracticeLocationAddress": "218 S MAPLE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENSBURG",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "15601-3200",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-335-3334",
"PracticeLocationAddressFaxNumber": "724-335-2283",
"EnumerationDate": "11/14/2019",
"LastUpdateDate": "11/14/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAYAKRISHNAN",
"AuthorizedOfficialFirstName": "RAJI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "724-889-2777",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}