{
"Npi": {
"NPI": "1730315748",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LEWIS",
"FirstName": "BRAD",
"MiddleName": "L",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PAC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "529 KEYSTONE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRESSON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16630-1330",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-935-7279",
"MailingAddressFaxNumber": "814-886-5470",
"FirstLinePracticeLocationAddress": "225 KEYSTONE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CRESSON",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16630-1214",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "814-886-2911",
"PracticeLocationAddressFaxNumber": "814-886-2911",
"EnumerationDate": "06/04/2009",
"LastUpdateDate": "03/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "MA003125L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}