{
  "npi": "1386210367",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "AZZA",
    "authorized_official_last_name": "GHANDOUR",
    "authorized_official_telephone_number": "9042424220",
    "authorized_official_title_or_position": "Billing/Credentialing manager",
    "certification_date": "2021-06-01",
    "enumeration_date": "2021-06-01",
    "last_updated": "2021-06-01",
    "organization_name": "ANGEL KIDS PA",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "13241 BARTRAM PARK BLVD UNIT 209",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "JACKSONVILLE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "322585233",
      "state": "FL",
      "telephone_number": "904-242-4220"
    },
    {
      "address_1": "774 STATE ROAD 13",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "ST JOHNS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "322593857",
      "state": "FL",
      "telephone_number": "904-242-4220"
    }
  ],
  "taxonomies": [
    {
      "code": "208000000X",
      "desc": "Pediatrics",
      "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": "Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)",
    "certifying_board": "American Board of Pediatrics (ABP)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "37",
        "medicare_type": "Physician/Pediatric Medicine"
      }
    ]
  }
}