{
  "npi": "1639344716",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "KENNY",
    "authorized_official_last_name": "HEINE",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "8586252990",
    "authorized_official_title_or_position": "VP of Operations",
    "enumeration_date": "2008-04-29",
    "last_updated": "2016-06-09",
    "organization_name": "BEAVER MEDICAL GROUP LP",
    "organizational_subpart": "YES",
    "parent_organization_legal_business_name": "MEDVANTX, INC.",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "9276 SCRANTON RD",
      "address_2": "SUITE 100",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SAN DIEGO",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "921217701",
      "state": "CA"
    },
    {
      "address_1": "7000 BOULDER AVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "HIGHLAND",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "923463348",
      "state": "CA",
      "telephone_number": "909-862-1191"
    }
  ],
  "taxonomies": [
    {
      "code": "332900000X",
      "desc": "Non-Pharmacy Dispensing Site",
      "license": "A69210",
      "primary": true,
      "state": "CA",
      "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 Non-Pharmacy Dispensing Site",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": []
  }
}