{
  "npi": "1346374550",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "RN, PHN",
    "authorized_official_first_name": "LAURA",
    "authorized_official_last_name": "LARSON",
    "authorized_official_telephone_number": "3208434546",
    "authorized_official_title_or_position": "Administrator",
    "certification_date": "2026-09-15",
    "enumeration_date": "2007-03-16",
    "last_updated": "2026-09-15",
    "organization_name": "COUNTRYSIDE PUBLIC HEALTH SERVICE",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "201 13TH ST S",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "BENSON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "320-843-4094",
      "postal_code": "562151856",
      "state": "MN",
      "telephone_number": "320-843-4546"
    },
    {
      "address_1": "201 13TH ST S",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BENSON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "320-843-4094",
      "postal_code": "562151856",
      "state": "MN",
      "telephone_number": "320-843-4546"
    }
  ],
  "taxonomies": [
    {
      "code": "251K00000X",
      "desc": "Public Health or Welfare",
      "license": null,
      "primary": true,
      "state": "MN",
      "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": {
    "total_beneficiaries": "13",
    "total_services": "33",
    "total_medicare_allowed_amt": "2499.98",
    "top_hcpcs_services": [
      {
        "code": "90480",
        "description": "Admn sarscov2 vacc 1 dose",
        "services": "11",
        "beneficiaries": "11"
      },
      {
        "code": "91322",
        "description": "Sarscov2 vac 50 mcg/0.5ml im",
        "services": "11",
        "beneficiaries": "11"
      }
    ]
  },
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Agencies — Public Health or Welfare",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "60",
        "medicare_type": "Public Health or Welfare Agency"
      }
    ]
  }
}