{
  "npi": "1275833659",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "GORDON",
    "authorized_official_last_name": "EDWARDS",
    "authorized_official_middle_name": "T",
    "authorized_official_telephone_number": "7153875823",
    "authorized_official_title_or_position": "CFO/COO/AO",
    "certification_date": "2022-05-25",
    "enumeration_date": "2010-11-01",
    "last_updated": "2022-05-25",
    "organization_name": "BEAVER DAM COMMUNITY HOSPTIALS INC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "MARSHFIELD CLINIC HEALTH SYSTEM INC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1580 W JAMES ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "COLUMBUS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "539251001",
      "state": "WI",
      "telephone_number": "920-350-0235"
    },
    {
      "address_1": "1000 N OAK AVE",
      "address_2": "ATTN: PROVIDER ENROLLMENT SERVICES/WWP",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "MARSHFIELD",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "544495703",
      "state": "WI",
      "telephone_number": "715-389-0660"
    }
  ],
  "taxonomies": [
    {
      "code": "207Q00000X",
      "desc": "Family Medicine",
      "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": "Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)",
    "certifying_board": "American Board of Family Medicine (ABFM)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "08",
        "medicare_type": "Physician/Family Practice"
      }
    ]
  }
}