{
"Npi": {
"NPI": "1699895870",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
"ParentOrgTIN": null,
"OrgName": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
"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": "4000 GARDEN CITY DR FL 4",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HYATTSVILLE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20785-2418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-816-2424",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "201 N WASHINGTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FALLS CHURCH",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22046-4518",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-237-4000",
"PracticeLocationAddressFaxNumber": "703-536-1313",
"EnumerationDate": "03/30/2007",
"LastUpdateDate": "07/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SWINTON",
"AuthorizedOfficialFirstName": "COLLEEN",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "CREDENTIALING DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-257-2797",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}