{
"Npi": {
"NPI": "1538597521",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PAIN MANAGEMENT & HEALTHCARE OF WEST ALLIS, LLC",
"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": "6751 W GREENFIELD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST ALLIS",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53214-4966",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-777-5066",
"MailingAddressFaxNumber": "414-777-5067",
"FirstLinePracticeLocationAddress": "6751 W GREENFIELD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST ALLIS",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53214-4966",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-777-5066",
"PracticeLocationAddressFaxNumber": "414-777-5067",
"EnumerationDate": "10/29/2013",
"LastUpdateDate": "08/04/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON FARMER",
"AuthorizedOfficialFirstName": "BARBARA",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER, CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN, ARNP, FNP, PHD",
"AuthorizedOfficialTelephoneNumber": "414-777-5066",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "2798-33",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}