{
"Npi": {
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"IsOrgSubpart": "N",
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"OrgName": "SQUARE 1 HEALTHCARE COMPANY",
"LastName": null,
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"FirstLineMailingAddress": "401 CLIPPER RD",
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"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62711-8010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-953-0352",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "511 N NEIL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHAMPAIGN",
"PracticeLocationAddressStateName": "IL",
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"PracticeLocationAddressTelephoneNumber": "815-408-0833",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/27/2023",
"LastUpdateDate": "09/27/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABRAHAM",
"AuthorizedOfficialFirstName": "ARUN",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "217-953-0352",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}