{
"Npi": {
"NPI": "1851799001",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOSTON MEDICAL GROUP CALIFORNIA LLC",
"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": "23275 S POINTE DRIVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "LAGUNA HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-562-4578",
"MailingAddressFaxNumber": "423-949-3992",
"FirstLinePracticeLocationAddress": "207 S SANTA ANITA AVE",
"SecondLinePracticeLocationAddress": "P25A",
"PracticeLocationAddressCityName": "SAN GABRIEL",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91776",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-562-4578",
"PracticeLocationAddressFaxNumber": "423-949-3992",
"EnumerationDate": "12/19/2014",
"LastUpdateDate": "12/19/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMPSON",
"AuthorizedOfficialFirstName": "JOAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF CQRM",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-562-4578",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "G9455",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}