{
"Npi": {
"NPI": "1679387278",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PIONEER MEDICAL GROUP, PL",
"ParentOrgTIN": null,
"OrgName": "PIONEER MEDICAL GROUP CLINIC FOUNDATION",
"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": "13067 N TELECOM PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPLE TERRACE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33637-0926",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-450-7231",
"MailingAddressFaxNumber": "786-868-0001",
"FirstLinePracticeLocationAddress": "3500 E FLETCHER AVE STE 222",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TAMPA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33613-4712",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-450-7231",
"PracticeLocationAddressFaxNumber": "786-868-0001",
"EnumerationDate": "02/04/2025",
"LastUpdateDate": "02/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KHAN",
"AuthorizedOfficialFirstName": "MASOOD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "813-943-7784",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}