{
"Npi": {
"NPI": "1700819802",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BEREA CLINIC OF INTERNAL MEDICINE, PSC",
"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": "1036 ACE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEREA",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40403-1327",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "859-986-3124",
"MailingAddressFaxNumber": "859-986-9398",
"FirstLinePracticeLocationAddress": "1036 ACE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BEREA",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40403-1327",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-986-3124",
"PracticeLocationAddressFaxNumber": "859-986-9398",
"EnumerationDate": "07/09/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHLOEMER",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "859-986-3124",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}