{
"Npi": {
"NPI": "1548090533",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STREETMAN",
"FirstName": "THOMAS",
"MiddleName": "R",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "STREETMAN",
"OtherFirstName": "THOMAS",
"OtherMiddleName": "R",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DNP THOMAS S",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "8305 SHEPHERDSVILLE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40219-4532",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-209-5212",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8305 SHEPHERDSVILLE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOUISVILLE",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40219-4532",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-209-5212",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/05/2024",
"LastUpdateDate": "03/12/2026",
"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": "207PE0004X",
"TaxonomyName": "Emergency Medical Services (Emergency Medicine) Physician",
"LicenseNumber": "3049622",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "1762536",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LA2100X",
"TaxonomyName": "Acute Care Nurse Practitioner",
"LicenseNumber": "3049622",
"LicenseNumberStateCode": "KY",
"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."
}
]
}
}
}