{
"Npi": {
"NPI": "1578051116",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ST. LUKE'S WARREN PHYSICIAN GROUP, PC",
"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": "185 ROSEBERRY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILLIPSBURG",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08865-1690",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "755 MEMORIAL PKWY STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHILLIPSBURG",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08865-2771",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "908-847-2621",
"PracticeLocationAddressFaxNumber": "908-847-3045",
"EnumerationDate": "04/30/2018",
"LastUpdateDate": "05/08/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THOMAS",
"AuthorizedOfficialFirstName": "JAMIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP OF MEDICAL AFFAIRS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "908-847-2621",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QB0002X",
"TaxonomyName": "Obesity Medicine (Family Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}