{
"Npi": {
"NPI": "1588982656",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DACCARETT",
"FirstName": "SARAH",
"MiddleName": "MARIA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CLIFFORD",
"OtherFirstName": "SARAH",
"OtherMiddleName": "MARIA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "827 E PARK BLVD STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83712-7782",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-781-0412",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "827 E PARK BLVD STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83712-7782",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-781-0412",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2010",
"LastUpdateDate": "12/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207ZC0006X",
"TaxonomyName": "Clinical Pathology Physician",
"LicenseNumber": "7633610-1205",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZC0006X",
"TaxonomyName": "Clinical Pathology Physician",
"LicenseNumber": "MD161763",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZC0006X",
"TaxonomyName": "Clinical Pathology Physician",
"LicenseNumber": "M-12016",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}