{
"Npi": {
"NPI": "1790256261",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GLOSSER",
"FirstName": "JARED",
"MiddleName": "DEION",
"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": "606 RIDGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOUGLASSVILLE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19518-1242",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-306-8237",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 PROSPECT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST STROUDSBURG",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "18301-2956",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-422-3231",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/10/2018",
"LastUpdateDate": "09/23/2020",
"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": "2255A2300X",
"TaxonomyName": "Athletic Trainer",
"LicenseNumber": "RT007287",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}