{
"Npi": {
"NPI": "1649162413",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ENDOURA EFFECT, PLLC",
"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": "202 N CEDAR AVE STE 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OWATONNA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55060-2306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-243-0625",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1099 HELMO AVE N STE 230",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OAKDALE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55128-6037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-243-0625",
"PracticeLocationAddressFaxNumber": "855-462-3105",
"EnumerationDate": "07/16/2025",
"LastUpdateDate": "07/16/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMON",
"AuthorizedOfficialFirstName": "JILLIAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN",
"AuthorizedOfficialTelephoneNumber": "651-491-4946",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}