{
  "npi": "1174507420",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "JEN",
    "authorized_official_last_name": "LEWANDOWSKI",
    "authorized_official_telephone_number": "7038174030",
    "authorized_official_title_or_position": "DHA UBO",
    "certification_date": "2025-06-17",
    "enumeration_date": "2005-11-30",
    "last_updated": "2025-06-17",
    "organization_name": "460TH MEDGRP-BUCKLEY",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "460TH MEDGRP-BUCKLEY",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "275 S ASPEN ST STOP 89",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "AURORA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "800119562",
      "state": "CO",
      "telephone_number": "720-277-9493"
    },
    {
      "address_1": "275 S ASPEN ST STOP 89",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "AURORA",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "800119562",
      "state": "CO",
      "telephone_number": "720-277-9493"
    }
  ],
  "taxonomies": [
    {
      "code": "261Q00000X",
      "desc": "Clinic/Center",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QM1101X",
      "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "332000000X",
      "desc": "MilitaryU.S. Coast Guard Pharmacy",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "261QM1100X",
      "desc": "Clinic/Center, MilitaryU.S. Coast Guard Outpatient",
      "license": null,
      "primary": true,
      "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": []
  }
}