{
"Npi": {
"NPI": "1457734469",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VA ILLIANA HEALTHCARE SYSTEM",
"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": "6 HEDGE CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHAMPAIGN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61821-2015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1901 E MAIN ST",
"SecondLinePracticeLocationAddress": "MAIL SLOT 122",
"PracticeLocationAddressCityName": "DANVILLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61832-5117",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-554-3755",
"PracticeLocationAddressFaxNumber": "217-554-4813",
"EnumerationDate": "07/08/2015",
"LastUpdateDate": "07/08/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAHAM",
"AuthorizedOfficialFirstName": "BRYANNA",
"AuthorizedOfficialMiddleName": "ELYCE",
"AuthorizedOfficialTitle": "SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMSW",
"AuthorizedOfficialTelephoneNumber": "217-554-3755",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "6906-M",
"LicenseNumberStateCode": "AR",
"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."
}
}
}
}