{
  "npi": "1629360540",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "DEBORAH",
    "authorized_official_last_name": "CHRISTIAN",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "9209265840",
    "authorized_official_title_or_position": "Supervisor Revenue Cycle Pt Account",
    "certification_date": "2022-12-16",
    "enumeration_date": "2011-05-11",
    "last_updated": "2022-12-16",
    "organization_name": "CONSULTANTS LABORATORY OF WISCONSIN, LLC",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "CONSULTANTS LABORATORY OF WISCONSIN, LLC",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "933 NEWBURY ST",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "RIPON",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "549711730",
      "state": "WI",
      "telephone_number": "920-948-9147"
    },
    {
      "address_1": "430 E DIVISION ST",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "FOND DU LAC",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "920-929-0647",
      "postal_code": "549354560",
      "state": "WI",
      "telephone_number": "920-926-5840"
    }
  ],
  "taxonomies": [
    {
      "code": "291U00000X",
      "desc": "Clinical Medical Laboratory",
      "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": "CLIA-Certified Diagnostic Medical & Pathology Laboratory",
    "certifying_board": "CMS CLIA / College of American Pathologists (CAP)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "69",
        "medicare_type": "Clinical Laboratory"
      },
      {
        "medicare_code": "B4[14]",
        "medicare_type": "Histocompatibility Laboratory"
      }
    ]
  }
}