{
"Npi": {
"NPI": "1447728795",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ISLAND IMAGING, LLC",
"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": "18 CAPTAIN'S CROSSING",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAVANNAH",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31411-2104",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "912-547-5640",
"MailingAddressFaxNumber": "843-681-5999",
"FirstLinePracticeLocationAddress": "40 PALMETTO PARKWAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HILTON HEAD ISLAND",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29926",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-681-1999",
"PracticeLocationAddressFaxNumber": "843-681-5999",
"EnumerationDate": "11/05/2018",
"LastUpdateDate": "01/25/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAPIRO",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": "POTTER",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "912-547-5640",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology 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."
}
}
}
}