{
  "npi": "1023230539",
  "enumeration_type": "NPI-1",
  "basic": {
    "certification_date": "2024-12-15",
    "credential": "D.D.S.",
    "enumeration_date": "2007-05-03",
    "first_name": "KENNETH",
    "last_name": "ANDERSON",
    "last_updated": "2024-12-15",
    "middle_name": "LEROY",
    "name_prefix": "Dr.",
    "name_suffix": "III",
    "sex": "M",
    "sole_proprietor": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "4372 COMMERCIAL WAY",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "SPRING HILL",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "346061965",
      "state": "FL",
      "telephone_number": "352-596-6804"
    },
    {
      "address_1": "7520 EXCITEMENT DR",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "REUNION",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "347476748",
      "state": "FL",
      "telephone_number": "312-402-3250"
    }
  ],
  "taxonomies": [
    {
      "code": "204E00000X",
      "desc": "Oral & Maxillofacial Surgery",
      "license": "DN22380",
      "primary": true,
      "state": "FL",
      "taxonomy_group": ""
    },
    {
      "code": "1223S0112X",
      "desc": "Dentist, Oral and Maxillofacial Surgery",
      "license": "DN 22380",
      "primary": false,
      "state": "FL",
      "taxonomy_group": ""
    },
    {
      "code": "1223S0112X",
      "desc": "Dentist, Oral and Maxillofacial Surgery",
      "license": "D12714",
      "primary": false,
      "state": "MN",
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "02",
        "medicare_type": "Physician/General Surgery"
      },
      {
        "medicare_code": "85",
        "medicare_type": "Physician/Maxillofacial Surgery"
      }
    ]
  }
}