{
"Npi": {
"NPI": "1477918969",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHELLE CARRILLO-MASSA, M.D., P.A.",
"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": "1383 DAKOTA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JUPITER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33458-8407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-385-7591",
"MailingAddressFaxNumber": "561-625-0248",
"FirstLinePracticeLocationAddress": "11211 PROSPERITY FARMS RD",
"SecondLinePracticeLocationAddress": "SUITE D127",
"PracticeLocationAddressCityName": "PALM BEACH GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33410-3446",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-627-0990",
"PracticeLocationAddressFaxNumber": "561-625-0248",
"EnumerationDate": "12/28/2015",
"LastUpdateDate": "12/28/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARRILLO-MASSA",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/MEDICAL DOCTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "561-385-7591",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "ME115891",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}