{
"Npi": {
"NPI": "1609994037",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OCCUPATIONAL ORTHOPEDIC MEDICAL GROUP",
"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": "31938 TEMECULA PKWY # A337",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMECULA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92592-6810",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-414-3065",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "82013 DOCTOR CARREON BLVD STE G",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "INDIO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92201-5832",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-775-9500",
"PracticeLocationAddressFaxNumber": "760-775-9567",
"EnumerationDate": "03/26/2007",
"LastUpdateDate": "09/15/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "702-283-0085",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QX0100X",
"TaxonomyName": "Occupational Medicine Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2083X0100X",
"TaxonomyName": "Occupational Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}