{
"Npi": {
"NPI": "1952320350",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "ELLEN",
"MiddleName": "D",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GERETY",
"OtherFirstName": "ELLEN",
"OtherMiddleName": "D",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "22100 BOTHELL EVERETT HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOTHELL",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98021-8431",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-416-2932",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "23 INGALLS VILLAGE WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOXFORD",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01921-2248",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-416-2932",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/18/2006",
"LastUpdateDate": "12/05/2023",
"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": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "11090",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "0101276011",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "247042",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}