{
"Npi": {
"NPI": "1689077000",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST",
"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": "5725 NE 138TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTLAND",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97230-3409",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "844-854-9346",
"MailingAddressFaxNumber": "503-304-5721",
"FirstLinePracticeLocationAddress": "5940 ULALI DR NE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KEIZER",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97303-1500",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-854-9364",
"PracticeLocationAddressFaxNumber": "503-304-5721",
"EnumerationDate": "09/30/2014",
"LastUpdateDate": "06/01/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LYMAN",
"AuthorizedOfficialFirstName": "ALFRED",
"AuthorizedOfficialMiddleName": "E.",
"AuthorizedOfficialTitle": "EXEC DIRECTOR REGIONAL PHARMACY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PHARMD., BCPS",
"AuthorizedOfficialTelephoneNumber": "503-261-7980",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "RP-0002984",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}