{
  "npi": "1154074201",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "PT, DPT",
    "authorized_official_first_name": "MATTHEW",
    "authorized_official_last_name": "BONANDER",
    "authorized_official_middle_name": "ELLIS",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_telephone_number": "9405358105",
    "authorized_official_title_or_position": "Physical Therapist",
    "certification_date": "2024-10-01",
    "enumeration_date": "2022-01-29",
    "last_updated": "2024-10-01",
    "organization_name": "MATT BONANDER LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "4118 HERDSMAN DR",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "KRUM",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "762491556",
      "state": "TX",
      "telephone_number": "940-535-8105"
    },
    {
      "address_1": "4118 HERDSMAN DR",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "KRUM",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "762491556",
      "state": "TX",
      "telephone_number": "940-535-8105"
    }
  ],
  "taxonomies": [
    {
      "code": "225100000X",
      "desc": "Physical Therapist",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "225X00000X",
      "desc": "Occupational Therapist",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-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 Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "65",
        "medicare_type": "Physical Therapist in Private Practice"
      }
    ]
  }
}