{
"Npi": {
"NPI": "1790946929",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RDI VEIN LLC",
"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": "2502 GALEN DRIVE",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "CHAMPAIGN",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61821-7049",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-355-8346",
"MailingAddressFaxNumber": "217-355-8347",
"FirstLinePracticeLocationAddress": "2502 GALEN DRIVE",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "CHAMPAIGN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61821",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-355-8346",
"PracticeLocationAddressFaxNumber": "217-355-8347",
"EnumerationDate": "06/20/2008",
"LastUpdateDate": "12/20/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUFFOLO",
"AuthorizedOfficialFirstName": "ALDO",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "217-355-8346",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}