{
  "npi": "1346890076",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "ROSTISLAV",
    "authorized_official_last_name": "PUKSHANSKY",
    "authorized_official_telephone_number": "8479427575",
    "authorized_official_title_or_position": "Partner",
    "certification_date": "2022-02-03",
    "enumeration_date": "2019-09-15",
    "last_updated": "2022-02-03",
    "organization_name": "BLOOMER NURSING AND REHAB LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1840 PRIDDY ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BLOOMER",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "547241546",
      "state": "WI",
      "telephone_number": "715-568-2503"
    },
    {
      "address_1": "8170 MCCORMICK BLVD STE 119",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SKOKIE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "600762961",
      "state": "IL",
      "telephone_number": "847-942-7575"
    }
  ],
  "taxonomies": [
    {
      "code": "314000000X",
      "desc": "Skilled Nursing Facility",
      "license": null,
      "primary": true,
      "state": null,
      "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 Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)",
    "certifying_board": "CMS Five-Star Quality Rating System / State Department of Health",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "A1[8]",
        "medicare_type": "Skilled Nursing Facility"
      }
    ]
  }
}