{
"Npi": {
"NPI": "1548441611",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLUMBINE RIDGE FAMILY MEDICINE P C",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "965 PLATTE RIVER BLVD",
"SecondLineMailingAddress": "UNIT O, BLDG 1",
"MailingAddressCityName": "BRIGHTON",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80601-4353",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-655-9866",
"MailingAddressFaxNumber": "303-655-9869",
"FirstLinePracticeLocationAddress": "965 PLATTE RIVER BLVD",
"SecondLinePracticeLocationAddress": "UNIT O BLDG 1",
"PracticeLocationAddressCityName": "BRIGHTON",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80601-4353",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-655-9866",
"PracticeLocationAddressFaxNumber": "303-655-9869",
"EnumerationDate": "11/16/2007",
"LastUpdateDate": "11/16/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RODRIGUEZ",
"AuthorizedOfficialFirstName": "CARLOS",
"AuthorizedOfficialMiddleName": "GUSTAVO",
"AuthorizedOfficialTitle": "SHARE HOLDER/ DOCTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "303-875-8198",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "36368",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}