{
"Npi": {
"NPI": "1740642628",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KPR ENDOCRINOLOGY LLC",
"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": "20 GLENDALE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HINSDALE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60521-2829",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-487-3736",
"MailingAddressFaxNumber": "630-487-3738",
"FirstLinePracticeLocationAddress": "621 PLAINFIELD RD",
"SecondLinePracticeLocationAddress": "ST 107",
"PracticeLocationAddressCityName": "WILLOWBROOK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60527-5343",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-446-7527",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/22/2016",
"LastUpdateDate": "03/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YALAMANCHI",
"AuthorizedOfficialFirstName": "SUDHA",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "SOLE MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "630-487-3736",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RE0101X",
"TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
"LicenseNumber": "036121291",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"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."
}
}
}
}