{
  "npi": "1215687314",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "STEVE",
    "authorized_official_last_name": "KRZYMINSKI",
    "authorized_official_telephone_number": "4192216717",
    "authorized_official_title_or_position": "Executive VP",
    "certification_date": "2024-02-27",
    "enumeration_date": "2022-03-24",
    "last_updated": "2024-02-27",
    "organization_name": "ADVANTAGE PHYSICAL THERAPY & SPORTS REHAB, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "112 ASH ST STE A",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "SPOONER",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "715-635-3990",
      "postal_code": "548011487",
      "state": "WI",
      "telephone_number": "715-635-3979"
    },
    {
      "address_1": "PO BOX 150",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "LIMA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "419-222-0507",
      "postal_code": "458020150",
      "state": "OH",
      "telephone_number": "419-221-6717"
    }
  ],
  "taxonomies": [
    {
      "code": "261QR0400X",
      "desc": "Clinic/Center, Rehabilitation",
      "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": [
      {
        "medicare_code": "B4[14]",
        "medicare_type": "Rehabilitation Agency"
      },
      {
        "medicare_code": "B4[14]",
        "medicare_type": "Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services"
      }
    ]
  }
}