{
  "npi": "1154473296",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "MD",
    "authorized_official_first_name": "IN",
    "authorized_official_last_name": "PARK",
    "authorized_official_middle_name": "YOUNG",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2769644001",
    "authorized_official_title_or_position": "CEO",
    "enumeration_date": "2007-01-17",
    "last_updated": "2020-08-22",
    "organization_name": "CLINCH VALLEY NEPHROLOGY INC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "2951 W FRONT STREET",
      "address_2": "CVMP SUITE 1600",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "RICHLANDS",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "276-964-4003",
      "postal_code": "24641",
      "state": "VA",
      "telephone_number": "276-964-4001"
    },
    {
      "address_1": "2951 W FRONT STREET",
      "address_2": "CVMP SUITE B800",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "RICHLANDS",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "276-964-4003",
      "postal_code": "24641",
      "state": "VA",
      "telephone_number": "276-964-4001"
    }
  ],
  "taxonomies": [
    {
      "code": "207RN0300X",
      "desc": "Internal Medicine, Nephrology",
      "license": null,
      "primary": true,
      "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": "Board-Certified Nephrologist (Kidney Function, Stones & Dialysis Specialist)",
    "certifying_board": "American Board of Internal Medicine — Nephrology",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "11",
        "medicare_type": "Physician/Internal Medicine"
      },
      {
        "medicare_code": "39",
        "medicare_type": "Physician/Nephrology"
      }
    ]
  }
}