{
"Npi": {
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"IsOrgSubpart": "N",
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"OrgName": "FAMHEALTH PRIMARY CARE , PA",
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"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5720 CREEDMOOR RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27612-2256",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-782-0430",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5720 CREEDMOOR RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RALEIGH",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressTelephoneNumber": "919-782-0430",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/06/2016",
"LastUpdateDate": "08/06/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TALLMER",
"AuthorizedOfficialFirstName": "ENID",
"AuthorizedOfficialMiddleName": "MATOS",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": "PA-C",
"AuthorizedOfficialTelephoneNumber": "919-697-5388",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "C2016204005421",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}