{"npi":"1902018641","type":"NPI-1","status":"active","name":{"display":"Julie Stark MD","other":[{"code":"1","type":"Formerly known as","value":"DONNELLY, JULIE MARIA"}],"first":"JULIE","last":"STARK","middle":"MARIA","credential":"MD"},"specialty":{"primary_taxonomy":"207Q00000X","primary_taxonomy_description":"Family Medicine","slug":"family-medicine","schema_org_specialty":"PrimaryCare","all":[{"code":"207Q00000X","description":"Family Medicine","primary":false,"state":"IL","license":"036121864"},{"code":"207Q00000X","description":"Family Medicine","primary":true,"state":"IN","license":"01073161A"}]},"addresses":[{"purpose":"LOCATION","street_1":"436 E WASHINGTON BLVD","city":"FORT WAYNE","state":"IN","postal_code":"468023210","country_code":"US","phone":"2602097111","fax":"2602222835"},{"purpose":"MAILING","street_1":"11109 PARKVIEW PLAZA DR # 117","city":"FORT WAYNE","state":"IN","postal_code":"468451701","country_code":"US"}],"license":{"state":"IN","number":"01073161A"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"201190690","state":"IN","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20140108001530","type_code":"14-08","type_desc":"PRACTITIONER - FAMILY PRACTICE","state":"IN","pac_id":"5597814350"}]},"enumeration_date":"2007-05-04","last_updated":"2024-08-19","_meta":{"source":"NPPES","snapshot_date":"2024-08-19","doc_url":"https://findmynpi.com/api"}}