{
  "npi": "1174594451",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "MARK",
    "authorized_official_last_name": "ELLIOTT",
    "authorized_official_telephone_number": "2145219991",
    "authorized_official_title_or_position": "OPERATIONS MANAGER",
    "certification_date": "2024-06-12",
    "enumeration_date": "2006-01-27",
    "last_updated": "2024-06-12",
    "organization_name": "FIRST LONE STAR PHARMACY GROUP IV LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1246 S HIGHWAY 377",
      "address_2": "STE 100",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "PILOT POINT",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "940-686-9286",
      "postal_code": "762584353",
      "state": "TX",
      "telephone_number": "940-686-2218"
    },
    {
      "address_1": "1246 S HIGHWAY 377",
      "address_2": "STE 100",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "PILOT POINT",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "940-686-9286",
      "postal_code": "762584353",
      "state": "TX",
      "telephone_number": "940-686-2218"
    }
  ],
  "taxonomies": [
    {
      "code": "333600000X",
      "desc": "Pharmacy",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "3336C0003X",
      "desc": "Pharmacy, Community/Retail Pharmacy",
      "license": "29669",
      "primary": false,
      "state": "TX",
      "taxonomy_group": ""
    },
    {
      "code": "3336C0004X",
      "desc": "Pharmacy, Compounding Pharmacy",
      "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": {
    "total_beneficiaries": "18",
    "total_services": "36",
    "total_medicare_allowed_amt": "2031.3",
    "top_hcpcs_services": [
      {
        "code": "90653",
        "description": "Influenza vaccine, inactivated",
        "services": "18",
        "beneficiaries": "18"
      },
      {
        "code": "G0008",
        "description": "Administration of influenza virus vaccine",
        "services": "18",
        "beneficiaries": "18"
      }
    ]
  },
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Suppliers — Pharmacy",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "58",
        "medicare_type": "Medical Supply Company with Pharmacist"
      },
      {
        "medicare_code": "A5",
        "medicare_type": "Pharmacy"
      }
    ]
  }
}