{
  "npi": "1528765708",
  "enumeration_type": "NPI-1",
  "basic": {
    "certification_date": "2023-02-08",
    "enumeration_date": "2023-02-08",
    "first_name": "TEVIN",
    "last_name": "HENDERSON",
    "last_updated": "2023-02-08",
    "middle_name": "DONTE",
    "sex": "M",
    "sole_proprietor": "YES",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 1294",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "CROSS CITY",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "326281294",
      "state": "FL",
      "telephone_number": "352-210-5731"
    },
    {
      "address_1": "26638 SE HWY 19 STE B",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "OLD TOWN",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "326808539",
      "state": "FL",
      "telephone_number": "352-210-5731"
    }
  ],
  "taxonomies": [
    {
      "code": "246RP1900X",
      "desc": "Technician, Pathology, Phlebotomy",
      "license": "27458-164-935-1042",
      "primary": true,
      "state": "FL",
      "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 Technician, Pathology, Phlebotomy",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": []
  }
}