{
  "npi": "1477842573",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "MD",
    "authorized_official_first_name": "CLARENCE",
    "authorized_official_last_name": "BEAVERS",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "3366273194",
    "authorized_official_title_or_position": "Owner",
    "certification_date": "2023-08-10",
    "enumeration_date": "2011-03-30",
    "last_updated": "2023-08-10",
    "organization_name": "BEAVERS DERMATOLOGY & SKIN SURGERY, PLLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "207 E MEADOW RD STE 1",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "EDEN",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "336-627-3208",
      "postal_code": "272883469",
      "state": "NC",
      "telephone_number": "336-627-3194"
    },
    {
      "address_1": "PO BOX 1693",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "BRYSON CITY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "828-538-4441",
      "postal_code": "287131693",
      "state": "NC",
      "telephone_number": "336-967-0004"
    }
  ],
  "taxonomies": [
    {
      "code": "207N00000X",
      "desc": "Dermatology",
      "license": "39543",
      "primary": true,
      "state": "NC",
      "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 Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)",
    "certifying_board": "American Board of Dermatology (ABD)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "07",
        "medicare_type": "Physician/Dermatology"
      }
    ]
  }
}