{
"Npi": {
"NPI": "1588847784",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "GI ASSOCIATES",
"ParentOrgTIN": null,
"OrgName": "TINLEY WOODS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "18210 LA GRANGE RD",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "TINLEY PARK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60487-7722",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-424-1202",
"MailingAddressFaxNumber": "708-424-1395",
"FirstLinePracticeLocationAddress": "10500 S CICERO AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAK LAWN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60453-5205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-424-1202",
"PracticeLocationAddressFaxNumber": "708-424-1395",
"EnumerationDate": "12/11/2007",
"LastUpdateDate": "12/11/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OMALLEY",
"AuthorizedOfficialFirstName": "DEBORAH",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "BILLING MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MRS.",
"AuthorizedOfficialTelephoneNumber": "708-424-1202",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}