{
"Npi": {
"NPI": "1578638029",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WESTON",
"FirstName": "THOMAS",
"MiddleName": "D",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4 DEERWOOD AVE NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WADENA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56482-1296",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-631-1100",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4 DEERWOOD AVE NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WADENA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56482-1296",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-631-1100",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/21/2006",
"LastUpdateDate": "06/24/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "10417",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PAC0161",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}