{
  "npi": "1336907906",
  "enumeration_type": "NPI-1",
  "basic": {
    "certification_date": "2026-03-05",
    "credential": "DO",
    "enumeration_date": "2024-03-08",
    "first_name": "CONNOR",
    "last_name": "CACKOVIC",
    "last_updated": "2026-03-05",
    "sex": "M",
    "sole_proprietor": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "402 GOODRICH AVENUE",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "KITTERY",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "03904",
      "state": "ME"
    },
    {
      "address_1": "402 GOODRICH AVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "KITTERY",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "03904",
      "state": "ME",
      "telephone_number": "888-628-9633"
    }
  ],
  "taxonomies": [
    {
      "code": "2083P0011X",
      "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
      "license": "011862",
      "primary": true,
      "state": "AZ",
      "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 Allopathic & Osteopathic Physicians — Preventive Medicine, Undersea and Hyperbaric Medicine",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "84",
        "medicare_type": "Physician/Preventive Medicine"
      }
    ]
  }
}