{
"Npi": {
"NPI": "1821134644",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COURCHAINE",
"FirstName": "ADAM",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 W COUNTY LINE RD",
"SecondLineMailingAddress": "APT 31-202",
"MailingAddressCityName": "HIGHLANDS RANCH",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80129-6512",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "774-219-9311",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7200 E DRY CREEK RD STE G101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CENTENNIAL",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80112-2574",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-647-7460",
"PracticeLocationAddressFaxNumber": "720-684-5766",
"EnumerationDate": "01/29/2007",
"LastUpdateDate": "07/14/2021",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "4256",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "AP2155",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}