{
"Npi": {
"NPI": "1518407279",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IMPERIAL PAIN SPECIALISTS INC",
"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": "411 PRINCETON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNSON CITY",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37601-2049",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-641-0021",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "411 PRINCETON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JOHNSON CITY",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37601-2049",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-641-0021",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/28/2017",
"LastUpdateDate": "02/28/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SINGH",
"AuthorizedOfficialFirstName": "VIJAY",
"AuthorizedOfficialMiddleName": "RAJ",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "423-737-2318",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain Medicine Physician",
"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."
}
}
}
}