{
  "npi": "1629499132",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "MD",
    "authorized_official_first_name": "RONALD",
    "authorized_official_last_name": "PLACE",
    "authorized_official_middle_name": "JOSEPH",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "6053227903",
    "authorized_official_title_or_position": "President/CEO",
    "certification_date": "2024-11-13",
    "enumeration_date": "2013-12-31",
    "last_updated": "2024-11-13",
    "organization_name": "AVERA MCKENNAN",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "6100 S LOUISE AVE STE 1275",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "SIOUX FALLS",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "571086029",
      "state": "SD",
      "telephone_number": "605-322-8000"
    },
    {
      "address_1": "PO BOX 5045",
      "address_2": "ATTN: P.F.S. PROV ENROLLMT",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SIOUX FALLS",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "605-322-5191",
      "postal_code": "571175045",
      "state": "SD",
      "telephone_number": "605-322-3278"
    }
  ],
  "taxonomies": [
    {
      "code": "225100000X",
      "desc": "Physical Therapist",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "225X00000X",
      "desc": "Occupational Therapist",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "235Z00000X",
      "desc": "Speech-Language Pathologist,  ",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193400000X - Multiple Single Specialty Group"
    },
    {
      "code": "332B00000X",
      "desc": "Durable Medical Equipment & Medical Supplies",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": ""
    },
    {
      "code": "335E00000X",
      "desc": "Prosthetic/Orthotic Supplier",
      "license": null,
      "primary": false,
      "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 & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "65",
        "medicare_type": "Physical Therapist in Private Practice"
      }
    ]
  }
}