{
"Npi": {
"NPI": "1902119902",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BOGIN",
"FirstName": "STACI",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DPM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCCORVEY",
"OtherFirstName": "STACI",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3879 E 120TH AVE",
"SecondLineMailingAddress": "#337",
"MailingAddressCityName": "THORNTON",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80233-1658",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-328-2022",
"MailingAddressFaxNumber": "720-328-1224",
"FirstLinePracticeLocationAddress": "3655 E 104TH AVE",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "THORNTON",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80233-4469",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-328-2022",
"PracticeLocationAddressFaxNumber": "720-328-1224",
"EnumerationDate": "07/19/2010",
"LastUpdateDate": "09/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "POD-698",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}