{
"Npi": {
"NPI": "1700230539",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FARRELL",
"FirstName": "JENNIFER",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LOOMIS",
"OtherFirstName": "JENNIFER",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "D.O.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "10260 SILVERSIDE ST STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IJAMSVILLE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21754-9174",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-682-4100",
"MailingAddressFaxNumber": "301-682-9100",
"FirstLinePracticeLocationAddress": "10260 SILVERSIDE ST STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IJAMSVILLE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21754-9174",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-682-4100",
"PracticeLocationAddressFaxNumber": "301-682-9100",
"EnumerationDate": "04/18/2016",
"LastUpdateDate": "01/03/2025",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "H0096681",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}