{
"Npi": {
"NPI": "1588536197",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAGE SPINE PAIN AND NERVE CENTER",
"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": "38500 TANGER DR STE 110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH BRANCH",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55056-5402",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-337-8201",
"MailingAddressFaxNumber": "651-337-8211",
"FirstLinePracticeLocationAddress": "38500 TANGER DR STE 110",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH BRANCH",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55056-5402",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "440-821-7326",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/22/2025",
"LastUpdateDate": "12/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARY",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "440-821-7325",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208VP0000X",
"TaxonomyName": "Pain 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."
}
}
}
}