{
  "npi": "1285542720",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "ALEX",
    "authorized_official_last_name": "WILSON",
    "authorized_official_telephone_number": "9026086717",
    "authorized_official_title_or_position": "Manager",
    "certification_date": "2026-08-27",
    "enumeration_date": "2026-08-27",
    "last_updated": "2026-08-27",
    "organization_name": "804 MEDICAL SUPPLY LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "taxonomies": [
    {
      "code": "207X00000X",
      "desc": "Orthopaedic Surgery",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "208100000X",
      "desc": "Physical Medicine & Rehabilitation",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    }
  ],
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Physical Medicine & Rehabilitation",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "common_medicare_procedures": [
      "Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)",
      "Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination",
      "Preventive Screening, Patient Counseling & Multidisciplinary Referral"
    ],
    "common_part_d_therapeutic_classes": [
      "Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)"
    ]
  }
}