{
"Npi": {
"NPI": "1801116652",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LOOKING GLASS FOOT & ANKLE 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": "13105 SCHAVEY RD",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "DEWITT",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48820-9037",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-668-6166",
"MailingAddressFaxNumber": "517-668-6169",
"FirstLinePracticeLocationAddress": "13105 SCHAVEY RD",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "DEWITT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48820-9037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-668-6166",
"PracticeLocationAddressFaxNumber": "517-668-6169",
"EnumerationDate": "06/03/2010",
"LastUpdateDate": "10/25/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMONS",
"AuthorizedOfficialFirstName": "ANDREA",
"AuthorizedOfficialMiddleName": "KAY",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "517-668-6166",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "5901002235",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}