{
"Npi": {
"NPI": "1750614970",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHERN IOWA PAIN MANAGEMENT, PC",
"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": "PO BOX 2400",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERLOO",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50704-2400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "319-233-3044",
"MailingAddressFaxNumber": "319-233-0722",
"FirstLinePracticeLocationAddress": "2710 SAINT FRANCIS DR",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "WATERLOO",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50702-5619",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "319-272-3323",
"PracticeLocationAddressFaxNumber": "319-272-3320",
"EnumerationDate": "09/08/2009",
"LastUpdateDate": "09/08/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "INAMDAR",
"AuthorizedOfficialFirstName": "GAYATHRY",
"AuthorizedOfficialMiddleName": "MURTHY",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "319-233-3044",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207LP2900X",
"TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
"LicenseNumber": "33957",
"LicenseNumberStateCode": "IA",
"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."
}
}
}
}