{
"Npi": {
"NPI": "1649392200",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAMILY PRACTICE MEDICAL",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6318 BERMUDA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83709-1009",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-378-0070",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "777 N RAYMOND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83704-9251",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-367-6030",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/04/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AHLRICHS",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "SOCIAL WORKER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "208-367-6030",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "LCSW-24633",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}