{
  "npi": "1275357378",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "CPO",
    "authorized_official_first_name": "ADAM",
    "authorized_official_last_name": "FANN",
    "authorized_official_middle_name": "LEE",
    "authorized_official_name_prefix": "Mr.",
    "authorized_official_telephone_number": "4239759884",
    "authorized_official_title_or_position": "Owner",
    "certification_date": "2026-08-03",
    "enumeration_date": "2024-11-14",
    "last_updated": "2026-08-03",
    "organization_name": "GRAYBEAL ORTHOPEDIC LLC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "GRAYBEAL ORTHOPEDIC LLC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "107 E MYRTLE AVE",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "JOHNSON CITY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "423-975-6678",
      "postal_code": "376014631",
      "state": "TN",
      "telephone_number": "423-975-9884"
    },
    {
      "address_1": "127 WILLOW DR STE F",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MAYKING",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "606-203-2780",
      "postal_code": "418378303",
      "state": "KY",
      "telephone_number": "606-331-3188"
    }
  ],
  "taxonomies": [
    {
      "code": "335E00000X",
      "desc": "Prosthetic/Orthotic Supplier",
      "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 & Credentialed Suppliers — Prosthetic — Orthotic Supplier",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "51",
        "medicare_type": "Medical Supply Company with Orthotist"
      },
      {
        "medicare_code": "52",
        "medicare_type": "Medical Supply Company with Prosthetist"
      },
      {
        "medicare_code": "53",
        "medicare_type": "Medical Supply Company with Orthotist-Prosthetist"
      }
    ]
  }
}