{
  "resourceType": "PractitionerRole",
  "id": "practitioner-role-1740849520-aba52f928da9",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2026-10-12T16:58:49.841+00:00",
    "source": "#I4jUeXvotDsITCqV",
    "profile": [ "http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/plannet-PractitionerRole" ]
  },
  "extension": [ {
    "url": "http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/network-reference",
    "valueReference": {
      "reference": "Organization/organization-fb309148-e76c-4549-b268-fe66bd6535a2"
    }
  }, {
    "url": "http://hl7.org/fhir/us/davinci-pdex-plan-net/StructureDefinition/newpatients",
    "extension": [ {
      "url": "acceptingPatients",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/AcceptingPatientsCS",
          "code": "newpt"
        } ]
      }
    } ]
  } ],
  "identifier": [ {
    "use": "official",
    "type": {
      "coding": [ {
        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
        "code": "PRN",
        "display": "Provider number"
      } ],
      "text": "NPI"
    },
    "system": "http://hl7.org/fhir/sid/us-npi",
    "value": "1740849520",
    "assigner": {
      "display": "CMS"
    }
  } ],
  "active": true,
  "period": {
    "start": "2027-01-01",
    "end": "2027-12-31"
  },
  "practitioner": {
    "reference": "Practitioner/practitioner-1740849520"
  },
  "organization": {
    "reference": "Organization/organization-e6ec283d-a65c-4a4b-8764-7c7df2e4bc16"
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    "coding": [ {
      "system": "http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/PlanNetPractitionerRoleCS",
      "code": "ph",
      "display": "Physician"
    } ]
  } ],
  "specialty": [ {
    "coding": [ {
      "system": "http://nucc.org/provider-taxonomy",
      "code": "207R00000X"
    } ]
  }, {
    "coding": [ {
      "system": "http://nucc.org/provider-taxonomy",
      "code": "390200000X"
    } ]
  }, {
    "coding": [ {
      "system": "http://nucc.org/provider-taxonomy",
      "code": "207RG0100X"
    } ]
  } ],
  "location": [ {
    "reference": "Location/location-072e09e8-0b9b-4dac-944e-10f15dea4700"
  } ],
  "telecom": [ {
    "system": "phone",
    "value": "3464741937",
    "use": "work"
  }, {
    "system": "fax",
    "value": "3464722301",
    "use": "work"
  } ]
}