{
"Npi": {
"NPI": "1861942849",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLSPACE HEALTH",
"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": "1820 J ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95811-3010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-550-5481",
"MailingAddressFaxNumber": "916-822-8974",
"FirstLinePracticeLocationAddress": "6015 WATT AVE",
"SecondLinePracticeLocationAddress": "#2",
"PracticeLocationAddressCityName": "NORTH HIGHLANDS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95660-4294",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-679-3925",
"PracticeLocationAddressFaxNumber": "916-679-3928",
"EnumerationDate": "10/13/2016",
"LastUpdateDate": "10/13/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOMEZ",
"AuthorizedOfficialFirstName": "JESSICA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MHA-I",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-679-3925",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QF0400X",
"TaxonomyName": "Federally Qualified Health Center (FQHC)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}