{
"Npi": {
"NPI": "1891423836",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAPITAL ORTHOPAEDICS AND SPINE",
"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": "4362 NORTHLAKE BLVD STE 209",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PALM BEACH GARDENS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33410-6270",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-345-2299",
"MailingAddressFaxNumber": "888-830-1589",
"FirstLinePracticeLocationAddress": "4362 NORTHLAKE BLVD STE 209",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PALM BEACH GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33410-6270",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-223-9606",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/09/2022",
"LastUpdateDate": "06/15/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORGAN",
"AuthorizedOfficialFirstName": "ASHLEY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CMPE",
"AuthorizedOfficialTelephoneNumber": "561-267-1817",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207XS0117X",
"TaxonomyName": "Orthopaedic Surgery of the Spine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QP1100X",
"TaxonomyName": "Podiatric Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
},
{
"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."
}
]
}
}
}