{
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  "enumeration_type": "NPI-2",
  "basic": {
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    "authorized_official_last_name": "COSTLEY",
    "authorized_official_telephone_number": "5406552936",
    "authorized_official_title_or_position": "Credentialing Specialist",
    "certification_date": "2026-01-30",
    "enumeration_date": "2026-01-07",
    "last_updated": "2026-01-30",
    "organization_name": "ADDICTION WELLNESS CENTER VA",
    "organizational_subpart": "YES",
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    "status": "A"
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    {
      "address_1": "1100 BUSINESS PKWY S STE 1",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "WESTMINSTER",
      "country_code": "US",
      "country_name": "United States",
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      "postal_code": "211573048",
      "state": "MD",
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    },
    {
      "address_1": "824 JOHN MARSHALL HWY STE 203",
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      "city": "FRONT ROYAL",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "540-736-4371",
      "postal_code": "226303744",
      "state": "VA",
      "telephone_number": "540-655-2936"
    }
  ],
  "taxonomies": [
    {
      "code": "363L00000X",
      "desc": "Nurse Practitioner",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    }
  ],
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    "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",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "50",
        "medicare_type": "Nurse Practitioner"
      }
    ]
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}