{
"Npi": {
"NPI": "1508454323",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CARDIOVASCULAR SOLUTIONS SAN ANTONIO",
"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": "5886 DE ZAVALA RD STE 102-460",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78249-2268",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-864-7922",
"MailingAddressFaxNumber": "210-905-9744",
"FirstLinePracticeLocationAddress": "6028 SPRING TIME ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78249-2452",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "325-374-7107",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/07/2021",
"LastUpdateDate": "11/26/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NELSON",
"AuthorizedOfficialFirstName": "AARON",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRESIDENT/CLINICAL DEVELOPMENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CLINICIAN",
"AuthorizedOfficialTelephoneNumber": "325-374-7107",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225B00000X",
"TaxonomyName": "Pulmonary Function Technologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246X00000X",
"TaxonomyName": "Cardiovascular Specialist/Technologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246XS1301X",
"TaxonomyName": "Sonography Specialist/Technologist Cardiovascular",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246ZE0600X",
"TaxonomyName": "Electroneurodiagnostic Specialist/Technologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "224Y00000X",
"TaxonomyName": "Clinical Exercise Physiologist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "293D00000X",
"TaxonomyName": "Physiological Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}