{
  "npi": "1326100595",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "OTRL",
    "authorized_official_first_name": "MARK",
    "authorized_official_last_name": "CONSTANTINO",
    "authorized_official_middle_name": "E",
    "authorized_official_name_prefix": "Mr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "7164846659",
    "authorized_official_title_or_position": "Occupational Therapist",
    "enumeration_date": "2006-12-14",
    "last_updated": "2020-08-22",
    "organization_name": "HERITAGE GREEN HEALTH CARE CENTER",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "5 CHARLES ST",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "FREWSBURG",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "147389547",
      "state": "NY",
      "telephone_number": "716-569-2240"
    },
    {
      "address_1": "3023 RTE 430",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "GREENHURST",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "14742",
      "state": "NY",
      "telephone_number": "716-484-6659"
    }
  ],
  "taxonomies": [
    {
      "code": "225X00000X",
      "desc": "Occupational Therapist",
      "license": "5569724",
      "primary": true,
      "state": "NY",
      "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 Occupational Therapist (OTR/L — Functional & Daily Living Rehab)",
    "certifying_board": "National Board for Certification in Occupational Therapy (NBCOT)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "67",
        "medicare_type": "Occupational Therapist in Private Practice"
      }
    ]
  }
}