{
"Npi": {
"NPI": "1609211291",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLARISA I. SMITH, MD PLLC",
"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": "111 CHESTER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANNAPOLIS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21403-3311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-431-1152",
"MailingAddressFaxNumber": "602-431-2149",
"FirstLinePracticeLocationAddress": "3001 N MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 1C",
"PracticeLocationAddressCityName": "PRESCOTT VALLEY",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86314-1216",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-458-5470",
"PracticeLocationAddressFaxNumber": "928-458-5979",
"EnumerationDate": "05/08/2013",
"LastUpdateDate": "09/10/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SORENSEN",
"AuthorizedOfficialFirstName": "KIRSTEN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "602-431-1152",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "35537",
"LicenseNumberStateCode": "AZ",
"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."
}
}
}
}