{
"Npi": {
"NPI": "1518353192",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CORREA",
"FirstName": "JESUS",
"MiddleName": "ALFREDO",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CORREA",
"OtherFirstName": "JESUS",
"OtherMiddleName": "ALFREDO",
"OtherNamePrefix": null,
"OtherNameSuffix": "JR.",
"OtherCredential": "MD",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2800 S TEXAS AVE STE 202",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRYAN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77802-5361",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "979-680-5474",
"MailingAddressFaxNumber": "979-680-5478",
"FirstLinePracticeLocationAddress": "2801 FRANCISCAN DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRYAN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77802-2544",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "979-776-5967",
"PracticeLocationAddressFaxNumber": "979-731-5916",
"EnumerationDate": "04/10/2015",
"LastUpdateDate": "06/19/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207L00000X",
"TaxonomyName": "Anesthesiology Physician",
"LicenseNumber": "D0089143",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208VP0014X",
"TaxonomyName": "Interventional Pain Medicine Physician",
"LicenseNumber": "MD.61122723",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208VP0014X",
"TaxonomyName": "Interventional Pain Medicine Physician",
"LicenseNumber": "D0089143",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208VP0014X",
"TaxonomyName": "Interventional Pain Medicine Physician",
"LicenseNumber": "S2750",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}