{
  "npi": "1487797544",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "PharmD",
    "authorized_official_first_name": "HEATHER",
    "authorized_official_last_name": "BIBEAU",
    "authorized_official_middle_name": "LEIGH",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2187434444",
    "authorized_official_title_or_position": "Director of Pharmacy",
    "enumeration_date": "2007-02-15",
    "last_updated": "2023-03-07",
    "organization_name": "NORTHERN ITASCA HOSPITAL DISTRICT",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "NORTHERN ITASCA HOSPITAL DISTRICT",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 258",
      "address_2": "258 PINE TREE DRIVE",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "BIGFORK",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "218-743-4232",
      "postal_code": "566280258",
      "state": "MN",
      "telephone_number": "218-743-4444"
    },
    {
      "address_1": "258 PINE TREE DRIVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BIGFORK",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "218-743-4232",
      "postal_code": "566280258",
      "state": "MN",
      "telephone_number": "218-743-4444"
    }
  ],
  "taxonomies": [
    {
      "code": "3336L0003X",
      "desc": "Pharmacy, Long Term Care Pharmacy",
      "license": "261348",
      "primary": false,
      "state": "MN",
      "taxonomy_group": ""
    },
    {
      "code": "3336C0003X",
      "desc": "Pharmacy, Community/Retail Pharmacy",
      "license": "261348",
      "primary": true,
      "state": "MN",
      "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 & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "58",
        "medicare_type": "Medical Supply Company with Pharmacist"
      },
      {
        "medicare_code": "A5",
        "medicare_type": "Pharmacy"
      }
    ]
  }
}