{
"Npi": {
"NPI": "1972639219",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED OPEN MRI",
"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": "2111 WILSON BLVD",
"SecondLineMailingAddress": "#700 PENN COMPANIES",
"MailingAddressCityName": "ARLINGTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22201-3001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-524-0400",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9802 FM 1960 BYPASS RD W",
"SecondLinePracticeLocationAddress": "#110",
"PracticeLocationAddressCityName": "HUMBLE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77338-3501",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-446-2514",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/23/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DE LEON",
"AuthorizedOfficialFirstName": "GRACIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "281-446-2514",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"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."
}
}
}
}