{
"Npi": {
"NPI": "1477766186",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RIVER FOREST MEDICAL ASSOC 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": "7353 NORTH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVER FOREST",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60305-1278",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-867-6087",
"MailingAddressFaxNumber": "708-867-6032",
"FirstLinePracticeLocationAddress": "7353 NORTH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVER FOREST",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60305-1278",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-867-6087",
"PracticeLocationAddressFaxNumber": "708-867-6032",
"EnumerationDate": "05/08/2007",
"LastUpdateDate": "05/06/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SARANTOS",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "708-867-6087",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "036066094",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}