{
  "npi": "1164129755",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "FNP-BC, PMHNP-BC",
    "authorized_official_first_name": "TANYA",
    "authorized_official_last_name": "COCKRELL",
    "authorized_official_middle_name": "S",
    "authorized_official_name_prefix": "Mrs.",
    "authorized_official_telephone_number": "6626305001",
    "authorized_official_title_or_position": "owner/operator",
    "certification_date": "2025-04-25",
    "enumeration_date": "2023-02-14",
    "last_updated": "2025-04-25",
    "organization_name": "4D HEALTHCARE, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1324 MILITARY RD",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "COLUMBUS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "397013616",
      "state": "MS",
      "telephone_number": "662-630-5001"
    },
    {
      "address_1": "1324 MILITARY RD",
      "address_purpose": "LOCATION",
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      "city": "COLUMBUS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "397013616",
      "state": "MS",
      "telephone_number": "662-630-5001"
    }
  ],
  "taxonomies": [
    {
      "code": "261QM0801X",
      "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QM1300X",
      "desc": "Clinic/Center, Multi-Specialty",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QP2300X",
      "desc": "Clinic/Center, Primary Care",
      "license": null,
      "primary": false,
      "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": [
      {
        "medicare_code": "70",
        "medicare_type": "Clinic or Group Practice"
      }
    ]
  }
}