{
"Npi": {
"NPI": "1992945935",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIAGNOSTIC IMAGING CENTERS OF NEPA, LLC",
"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": "1000 MEADE ST",
"SecondLineMailingAddress": "MEDICAL PLAZA",
"MailingAddressCityName": "DUNMORE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18512-3195",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-504-2519",
"MailingAddressFaxNumber": "570-504-2599",
"FirstLinePracticeLocationAddress": "111 HULST DR",
"SecondLinePracticeLocationAddress": "STE 708",
"PracticeLocationAddressCityName": "MATAMORAS",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "18336-2115",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-491-9200",
"PracticeLocationAddressFaxNumber": "570-491-9201",
"EnumerationDate": "03/04/2009",
"LastUpdateDate": "03/04/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BODNAR",
"AuthorizedOfficialFirstName": "LORI",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "DIRECTOR OF BILLING/CONTRACTING",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RCC",
"AuthorizedOfficialTelephoneNumber": "570-504-2519",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}