{"npi":"1174783005","type":"NPI-1","status":"active","name":{"display":"Mary Porta PA-C","other":[{"code":"1","type":"Formerly known as","value":"GREEN, MARY THERESE"}],"first":"MARY","last":"PORTA","middle":"THERESE","credential":"PA-C"},"specialty":{"primary_taxonomy":"363A00000X","primary_taxonomy_description":"Physician Assistant","slug":"physician-assistant","schema_org_specialty":null,"all":[{"code":"363A00000X","description":"Physician Assistant","primary":true,"state":"MI","license":"5601005244"}]},"addresses":[{"purpose":"LOCATION","street_1":"44201 DEQUINDRE RD","city":"TROY","state":"MI","postal_code":"480851117","country_code":"US","street_2":"SUITE EC","phone":"2489645111","fax":"2489645068"},{"purpose":"MAILING","street_1":"26901 BEAUMONT BLVD STE 3D","city":"SOUTHFIELD","state":"MI","postal_code":"480333849","country_code":"US","phone":"9475221865","fax":"9475220307"}],"license":{"state":"MI","number":"5601005244"},"identifiers":[{"type_code":"01","label":"Other","value":"110F376980","state":"MI","issuer":"BCBSM"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20080723000215","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"MI","pac_id":"7315010402"}]},"enumeration_date":"2008-06-13","last_updated":"2022-07-28","_meta":{"source":"NPPES","snapshot_date":"2022-07-28","doc_url":"https://findmynpi.com/api"}}