{
"Npi": {
"NPI": "1740443118",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SULLIVAN",
"FirstName": "ALICE",
"MiddleName": "PRESCOTT",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PRESCOTT",
"OtherFirstName": "ALICE",
"OtherMiddleName": "BENJAMIN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DO",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 877",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21044-0877",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-777-9804",
"MailingAddressFaxNumber": "855-488-4577",
"FirstLinePracticeLocationAddress": "PO BOX 877",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21044-0877",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-308-8675",
"PracticeLocationAddressFaxNumber": "855-488-4577",
"EnumerationDate": "07/07/2008",
"LastUpdateDate": "03/06/2026",
"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": "98423",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "H0101656",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "34.013517",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}