{
"Npi": {
"NPI": "1568772820",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAIRMOUNT PODIATRY GROUP",
"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": "7524 FAIRMOUNT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL CERRITO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94530-3746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-526-4244",
"MailingAddressFaxNumber": "510-526-9251",
"FirstLinePracticeLocationAddress": "7524 FAIRMOUNT AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EL CERRITO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94530-3746",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-526-4244",
"PracticeLocationAddressFaxNumber": "510-526-9251",
"EnumerationDate": "10/20/2010",
"LastUpdateDate": "04/04/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAHMIE",
"AuthorizedOfficialFirstName": "DARLENE",
"AuthorizedOfficialMiddleName": "JO",
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "510-526-4266",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": "E3401",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}