{
  "npi": "1336439645",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "M.D.",
    "authorized_official_first_name": "DAVID",
    "authorized_official_last_name": "ELLIS",
    "authorized_official_middle_name": "J",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "6103825910",
    "authorized_official_title_or_position": "President",
    "certification_date": "2024-04-03",
    "enumeration_date": "2011-04-08",
    "last_updated": "2024-04-03",
    "organization_name": "ACADEMIC UROLOGY OF PA, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "919 CONESTOGA RD",
      "address_2": "BUILDING 1 SUITE 300",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BRYN MAWR",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "610-525-3664",
      "postal_code": "190101352",
      "state": "PA",
      "telephone_number": "610-525-6580"
    },
    {
      "address_1": "211 S GULPH RD",
      "address_2": "SUITE 200",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "KING OF PRUSSIA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "610-382-5918",
      "postal_code": "194063112",
      "state": "PA",
      "telephone_number": "610-382-5910"
    }
  ],
  "taxonomies": [
    {
      "code": "261QA1903X",
      "desc": "Clinic/Center, Ambulatory Surgical",
      "license": "50421501",
      "primary": true,
      "state": "PA",
      "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 Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "49",
        "medicare_type": "Ambulatory Surgical Center"
      }
    ]
  }
}