{
"Npi": {
"NPI": "1780069179",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AD-VIE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5939 W GREEN BROOK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROWN DEER",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53223-2336",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-339-1084",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5939 W GREEN BROOK DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROWN DEER",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53223-2336",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-339-1084",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/27/2015",
"LastUpdateDate": "07/27/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GILET",
"AuthorizedOfficialFirstName": "JEANNE",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "HEALTH MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "619-339-1084",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "735742",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}