{
  "npi": "1609563618",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "DC",
    "authorized_official_first_name": "NATHAN",
    "authorized_official_last_name": "MILLER",
    "authorized_official_middle_name": "DEE",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_telephone_number": "8018992053",
    "authorized_official_title_or_position": "CEO",
    "certification_date": "2023-04-19",
    "enumeration_date": "2023-04-19",
    "last_updated": "2023-04-19",
    "organization_name": "FIRST CARE CONCUSSION DIAGNOSTIC CLINICS OF IDAHO, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1988 W 930 N STE D",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "PLEASANT GROVE",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "385-365-5054",
      "postal_code": "840624132",
      "state": "UT",
      "telephone_number": "702-403-1103"
    },
    {
      "address_1": "24641 BLAZE AVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "MIDDLETON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "385-365-5054",
      "postal_code": "836446156",
      "state": "ID",
      "telephone_number": "702-403-1103"
    }
  ],
  "taxonomies": [
    {
      "code": "261QH0100X",
      "desc": "Clinic/Center, Health Services",
      "license": null,
      "primary": true,
      "state": null,
      "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 Outpatient Medical Clinic / Urgent Care & Ambulatory Center",
    "certifying_board": "Accreditation Association for Ambulatory Health Care (AAAHC) / CMS",
    "cms_medicare_crosswalk": []
  }
}