{
"Npi": {
"NPI": "1447404991",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "METRO CARDIOVASCULAR, INC.",
"ParentOrgTIN": null,
"OrgName": "METRO CARDIOVASCULAR, 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": "11115 NEW HALLS FERRY RD",
"SecondLineMailingAddress": "SUITE 301",
"MailingAddressCityName": "FLORISSANT",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63033-7613",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-921-6200",
"MailingAddressFaxNumber": "314-830-0756",
"FirstLinePracticeLocationAddress": "11115 NEW HALLS FERRY RD",
"SecondLinePracticeLocationAddress": "SUITE 301",
"PracticeLocationAddressCityName": "FLORISSANT",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63033-7613",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-921-6200",
"PracticeLocationAddressFaxNumber": "314-830-0756",
"EnumerationDate": "11/11/2008",
"LastUpdateDate": "11/12/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIDDIQUI",
"AuthorizedOfficialFirstName": "JAWED",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "314-921-6200",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "036-056278",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "R6047",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}