{
  "npi": "1609278308",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "TRISTAN",
    "authorized_official_last_name": "LIU",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "6468014876",
    "authorized_official_title_or_position": "Corporate Officer",
    "enumeration_date": "2014-09-24",
    "last_updated": "2014-09-24",
    "organization_name": "139 CENTER PHARMACY, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "139 CENTRE ST",
      "address_2": "STORE 105",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "NEW YORK",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "718-513-2047",
      "postal_code": "100134552",
      "state": "NY",
      "telephone_number": "646-838-6388"
    },
    {
      "address_1": "139 CENTRE ST",
      "address_2": "STORE 105",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "NEW YORK",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "718-513-2047",
      "postal_code": "100134552",
      "state": "NY",
      "telephone_number": "646-838-6388"
    }
  ],
  "taxonomies": [
    {
      "code": "3336C0003X",
      "desc": "Pharmacy, Community/Retail Pharmacy",
      "license": "033068",
      "primary": true,
      "state": "NY",
      "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": {
    "total_beneficiaries": "48",
    "total_services": "104",
    "total_medicare_allowed_amt": "13615.73",
    "top_hcpcs_services": [
      {
        "code": "90480",
        "description": "Admn sarscov2 vacc 1 dose",
        "services": "13",
        "beneficiaries": "12"
      },
      {
        "code": "90677",
        "description": "Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use",
        "services": "28",
        "beneficiaries": "26"
      },
      {
        "code": "91322",
        "description": "Sarscov2 vac 50 mcg/0.5ml im",
        "services": "13",
        "beneficiaries": "12"
      },
      {
        "code": "G0009",
        "description": "Administration of pneumococcal vaccine",
        "services": "34",
        "beneficiaries": "32"
      }
    ]
  },
  "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"
      }
    ]
  }
}