{
"Npi": {
"NPI": "1568301596",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "5 STAR HEALTH AND WELLNESS CLINIC 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": "7385 STATE ROUTE 3 UNIT 460",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTERVILLE",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43082-8654",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-406-1112",
"MailingAddressFaxNumber": "713-583-2081",
"FirstLinePracticeLocationAddress": "2900 KEY PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43207-2660",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-406-1112",
"PracticeLocationAddressFaxNumber": "713-583-2081",
"EnumerationDate": "03/26/2026",
"LastUpdateDate": "03/26/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAIRSTON",
"AuthorizedOfficialFirstName": "OZZIE",
"AuthorizedOfficialMiddleName": "AMENDA",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP,APRN,PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "281-406-1112",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}