{
  "npi": "1346876729",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "NP",
    "authorized_official_first_name": "ALISSA",
    "authorized_official_last_name": "FODOR",
    "authorized_official_telephone_number": "6179593994",
    "authorized_official_title_or_position": "NP/ Owner",
    "certification_date": "2025-02-17",
    "enumeration_date": "2020-03-18",
    "last_updated": "2025-02-17",
    "organization_name": "ALTA MENTAL HEALTH LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "100 HIGHLAND AVE STE 204",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "SALEM",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "019702702",
      "state": "MA",
      "telephone_number": "617-959-3994"
    },
    {
      "address_1": "100 HIGHLAND AVE STE 204",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SALEM",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "019702702",
      "state": "MA",
      "telephone_number": "617-959-3994"
    }
  ],
  "taxonomies": [
    {
      "code": "363LP0808X",
      "desc": "Nurse Practitioner, Psych/Mental Health",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193400000X - Single 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": "Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "50",
        "medicare_type": "Nurse Practitioner"
      }
    ]
  }
}