{
"Npi": {
"NPI": "1922402718",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALLINA HEALTH SYSTEM",
"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": "14700 28TH AVE N",
"SecondLineMailingAddress": "SUITE 20",
"MailingAddressCityName": "PLYMOUTH",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55447-4835",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "763-559-3791",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "701 DELLWOOD ST S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAMBRIDGE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55008-1920",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "763-689-7700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/22/2014",
"LastUpdateDate": "03/25/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TALLARICO",
"AuthorizedOfficialFirstName": "DOMINICA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "612-222-2222",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}