{
"Npi": {
"NPI": "1508782947",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEP MEDICAL GROUP PLLC",
"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": "2749 TRAILWOOD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANN ARBOR",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48105-9743",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-210-1627",
"MailingAddressFaxNumber": "614-482-4938",
"FirstLinePracticeLocationAddress": "3045 BAKER RD STE K",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DEXTER",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48130-1163",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-215-5768",
"PracticeLocationAddressFaxNumber": "614-482-4938",
"EnumerationDate": "06/29/2026",
"LastUpdateDate": "06/29/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOCKBRADER",
"AuthorizedOfficialFirstName": "MARCIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD PHD",
"AuthorizedOfficialTelephoneNumber": "614-286-0305",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2081P0301X",
"TaxonomyName": "Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2083A0300X",
"TaxonomyName": "Addiction Medicine (Preventive Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208100000X",
"TaxonomyName": "Physical Medicine & Rehabilitation Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}