{
  "npi": "1093211823",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "JERROD",
    "authorized_official_last_name": "ESTES",
    "authorized_official_telephone_number": "2179942046",
    "authorized_official_title_or_position": "CEO/Paramedic",
    "certification_date": "2021-08-09",
    "enumeration_date": "2018-04-02",
    "last_updated": "2021-08-09",
    "organization_name": "LAKESIDE EMS LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "815 S MAPLE ST",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "EFFINGHAM",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "724-794-1633",
      "postal_code": "624012641",
      "state": "IL",
      "telephone_number": "217-994-2046"
    },
    {
      "address_1": "815 S MAPLE ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "EFFINGHAM",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "724-794-1633",
      "postal_code": "624012641",
      "state": "IL",
      "telephone_number": "217-994-2046"
    }
  ],
  "taxonomies": [
    {
      "code": "3416L0300X",
      "desc": "Ambulance, Land Transport",
      "license": "060409935",
      "primary": true,
      "state": "IL",
      "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 Emergency Medical Services (EMS) — BLS/ALS Ground & Air Ambulance",
    "certifying_board": "State EMS Authority / National Registry of Emergency Medical Technicians (NREMT)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "59",
        "medicare_type": "Ambulance Service Provider"
      }
    ]
  }
}