{
"Npi": {
"NPI": "1992074066",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EMERALD CITY SPORTS & SPINE MEDICINE",
"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": "6924 SE ALLEN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERCER ISLAND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98040-3357",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "206-852-8898",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1632 116TH AVE NE",
"SecondLinePracticeLocationAddress": "STE C",
"PracticeLocationAddressCityName": "BELLEVUE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98004-3035",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-818-0558",
"PracticeLocationAddressFaxNumber": "888-557-3062",
"EnumerationDate": "12/20/2011",
"LastUpdateDate": "02/22/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HYMAN",
"AuthorizedOfficialFirstName": "GARRETT",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PHYSICIAN OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD, MPH",
"AuthorizedOfficialTelephoneNumber": "206-852-8898",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "MD 39116",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}