{
  "npi": "1073266292",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "MD",
    "authorized_official_first_name": "RONALD",
    "authorized_official_last_name": "BOULWARE",
    "authorized_official_middle_name": "GLEN",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_telephone_number": "8135460468",
    "authorized_official_title_or_position": "Physician",
    "certification_date": "2022-01-28",
    "enumeration_date": "2022-01-28",
    "last_updated": "2022-01-28",
    "organization_name": "BOULWARE P.A. INC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 788",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "MADISON",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "306500788",
      "state": "GA"
    },
    {
      "address_1": "216 N MAIN ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MADISON",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "306501313",
      "state": "GA",
      "telephone_number": "706-343-4100"
    }
  ],
  "taxonomies": [
    {
      "code": "261QP2300X",
      "desc": "Clinic/Center, Primary Care",
      "license": null,
      "primary": true,
      "state": null,
      "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 Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": []
  }
}