{
  "npi": "1194029736",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "DMD",
    "authorized_official_first_name": "ANDREW",
    "authorized_official_last_name": "MATTA",
    "authorized_official_middle_name": "S",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "3305333400",
    "authorized_official_title_or_position": "SOLE OWNER",
    "enumeration_date": "2010-12-22",
    "last_updated": "2010-12-22",
    "organization_name": "ANDREW S MATTA DMD BOARDMAN LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "3800 BOARDMAN CANFIELD RD",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "CANFIELD",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "330-533-2700",
      "postal_code": "444069029",
      "state": "OH",
      "telephone_number": "330-533-3400"
    },
    {
      "address_1": "6540 SOUTH AVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BOARDMAN",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "330-533-2700",
      "postal_code": "445123651",
      "state": "OH",
      "telephone_number": "330-758-6165"
    }
  ],
  "taxonomies": [
    {
      "code": "1223G0001X",
      "desc": "Dentist, General Practice",
      "license": "DS036253",
      "primary": true,
      "state": "PA",
      "taxonomy_group": "193400000X - Single 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 Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)",
    "certifying_board": "American Dental Association (ADA) / State Board of Dental Examiners",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "C5",
        "medicare_type": "Dentist"
      }
    ]
  }
}