{
  "npi": "1255570099",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "CCA",
    "authorized_official_first_name": "PAUL",
    "authorized_official_last_name": "TANNER",
    "authorized_official_middle_name": "BENJAMIN",
    "authorized_official_telephone_number": "8019970545",
    "authorized_official_title_or_position": "Owner",
    "certification_date": "2026-09-18",
    "enumeration_date": "2009-02-18",
    "last_updated": "2026-09-18",
    "organization_name": "CUSTOM DME",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "3187 S 200 E",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "BOUNTIFUL",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "888-977-5399",
      "postal_code": "840105718",
      "state": "UT",
      "telephone_number": "801-997-0545"
    },
    {
      "address_1": "1455 S 500 W STE D",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BOUNTIFUL",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "888-977-5399",
      "postal_code": "840108252",
      "state": "UT",
      "telephone_number": "801-997-0545"
    }
  ],
  "taxonomies": [
    {
      "code": "156FX1700X",
      "desc": "Technician/Technologist, Ocularist",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "229N00000X",
      "desc": "Anaplastologist",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-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 & Credentialed Respiratory, Developmental, Rehabilitative, and Restorative Service Providers — Anaplastologist",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "56",
        "medicare_type": "Individual Certified Prosthetist"
      },
      {
        "medicare_code": "57",
        "medicare_type": "Individual Certified Prosthetist-Orthotist"
      }
    ]
  }
}