{
"Npi": {
"NPI": "1538439435",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IBRAHIM S UMAR M P C",
"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": "4200 N CLOVERLEAF DR",
"SecondLineMailingAddress": "SUITE N",
"MailingAddressCityName": "SAINT PETERS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63376-6436",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-922-9182",
"MailingAddressFaxNumber": "636-922-9183",
"FirstLinePracticeLocationAddress": "4200 N CLOVERLEAF DR",
"SecondLinePracticeLocationAddress": "SUITE N",
"PracticeLocationAddressCityName": "SAINT PETERS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63376-6436",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-922-9182",
"PracticeLocationAddressFaxNumber": "636-922-9183",
"EnumerationDate": "01/09/2012",
"LastUpdateDate": "05/22/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UMAR",
"AuthorizedOfficialFirstName": "IBRAHIM",
"AuthorizedOfficialMiddleName": "SULEMAN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "636-922-9182",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "R8426",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}