{
"Npi": {
"NPI": "1558501551",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRIANGLE FOOT AND ANKLE SPECIALIST, 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": "217 DAVIS ST.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHERN PINES",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28387",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-757-0058",
"MailingAddressFaxNumber": "910-757-0164",
"FirstLinePracticeLocationAddress": "217 DAVIS ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHERN PINES",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28387",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-757-0058",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/03/2009",
"LastUpdateDate": "07/13/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THOMAS",
"AuthorizedOfficialFirstName": "JEREMY",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M",
"AuthorizedOfficialTelephoneNumber": "919-961-6215",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "542",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}