{
  "npi": "1417009408",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "NANCY",
    "authorized_official_last_name": "FORD",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "4109564308",
    "authorized_official_title_or_position": "Business Manager",
    "enumeration_date": "2007-01-18",
    "last_updated": "2020-08-22",
    "organization_name": "BAYSIDE PHYSICAL THERAPY AND SPORTS REHABILITATION, INC.",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "3179 BRAVERTON ST",
      "address_2": "SUITE 201",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "EDGEWATER",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "210372665",
      "state": "MD",
      "telephone_number": "410-956-4308"
    },
    {
      "address_1": "8601 VETERANS HWY",
      "address_2": "SUITE 212",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MILLERSVILLE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "211081547",
      "state": "MD",
      "telephone_number": "410-987-2162"
    }
  ],
  "taxonomies": [
    {
      "code": "225100000X",
      "desc": "Physical Therapist",
      "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 Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "65",
        "medicare_type": "Physical Therapist in Private Practice"
      }
    ]
  }
}