{
"Npi": {
"NPI": "1861770182",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SURGICAL PARTNERS",
"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": "PO BOX 437",
"SecondLineMailingAddress": "SURGICAL PARTNERS",
"MailingAddressCityName": "CHICAGO RIDGE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60415-0437",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-731-4949",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4440 W 95TH ST",
"SecondLinePracticeLocationAddress": "ADVOCATE MEDICAL GROUP - SURGICAL PARTNERS",
"PracticeLocationAddressCityName": "OAK LAWN",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60453-2600",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-731-4949",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/03/2011",
"LastUpdateDate": "08/03/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAKSOUD",
"AuthorizedOfficialFirstName": "YASER",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT AND CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "312-731-4949",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "238.000220",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}