{
"Npi": {
"NPI": "1649764978",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SAMPSON",
"FirstName": "MELISSA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "55 FRUIT ST",
"SecondLineMailingAddress": "MGH GRB 260 INTERVENTIONAL RADIOLOGY",
"MailingAddressCityName": "BOSTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02114-2621",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "781-439-1250",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "201 SYLVIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARLINGTON",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02476-7008",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-439-1250",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/20/2018",
"LastUpdateDate": "03/06/2019",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0204X",
"TaxonomyName": "Vascular & Interventional Radiology Physician",
"LicenseNumber": "PA6695",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}