| Name | Description | Type | Additional information |
|---|---|---|---|
| SPI | string |
None. |
|
| NPI | string |
None. |
|
| Prefix | string |
None. |
|
| LastName | string |
None. |
|
| FirstName | string |
None. |
|
| MiddleName | string |
None. |
|
| Suffix | string |
None. |
|
| AddressLine1 | string |
None. |
|
| AddressLine2 | string |
None. |
|
| City | string |
None. |
|
| StateProvince | string |
None. |
|
| PostalCode | string |
None. |
|
| CountryCode | string |
None. |
|
| PrimaryTelephone | string |
None. |
|
| Fax | string |
None. |
|
| ElectronicMail | string |
None. |
|
| ActiveStartTime | string |
None. |
|
| ActiveEndTime | string |
None. |