{
"Npi": {
"NPI": "1871769000",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MED CENTER MEDICAL CLINIC, INC",
"ParentOrgTIN": null,
"OrgName": "MED CENTER MEDICAL CLINIC, INC",
"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": "6060 SUNRISE VISTA DR",
"SecondLineMailingAddress": "STE 3050",
"MailingAddressCityName": "CITRUS HEIGHTS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95610-7053",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-676-1450",
"MailingAddressFaxNumber": "916-676-1447",
"FirstLinePracticeLocationAddress": "7988 CALIFORNIA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAIR OAKS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95628-7140",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-961-7031",
"PracticeLocationAddressFaxNumber": "916-961-5218",
"EnumerationDate": "05/07/2008",
"LastUpdateDate": "01/22/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ADGE",
"AuthorizedOfficialFirstName": "CINDY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-676-1450",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA10071",
"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."
}
}
}
}