{
  "npi": "1083841076",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "MICHAEL",
    "authorized_official_last_name": "NELSON",
    "authorized_official_name_prefix": "Mr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "7082094156",
    "authorized_official_title_or_position": "CFO",
    "enumeration_date": "2009-06-17",
    "last_updated": "2009-06-17",
    "organization_name": "AERIES HEALTHCARE OF ILLINOIS PHYSICIAN GROUP",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "RIVEREDEGE HOSPITAL",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 840936",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "DALLAS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "72584",
      "state": "TX",
      "telephone_number": "708-209-4152"
    },
    {
      "address_1": "8311 W ROOSEVELT RD",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "FOREST PARK",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "60130",
      "state": "IL",
      "telephone_number": "708-209-4150"
    }
  ],
  "taxonomies": [
    {
      "code": "103TP0016X",
      "desc": "Psychologist, Prescribing (Medical)",
      "license": null,
      "primary": true,
      "state": "IL",
      "taxonomy_group": "193400000X - Single Specialty 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 Behavioral Health & Social Service Providers — Psychologist, Prescribing (Medical)",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "62",
        "medicare_type": "Psychologist, Clinical"
      }
    ]
  }
}