{
  "npi": "1669651618",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "ROSE MARIE",
    "authorized_official_last_name": "RIVERA",
    "authorized_official_name_prefix": "Ms.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "8055778730",
    "authorized_official_title_or_position": "ADMINISTRATOR",
    "certification_date": "2020-03-24",
    "enumeration_date": "2007-10-26",
    "last_updated": "2020-03-24",
    "organization_name": "ALBERT C MAK MD INC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 80520",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "SAN MARINO",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "805-991-4065",
      "postal_code": "911188520",
      "state": "CA",
      "telephone_number": "805-577-8730"
    },
    {
      "address_1": "707 S GARFIELD AVE",
      "address_2": "BSMT",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "ALHAMBRA",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "805-991-4065",
      "postal_code": "918015859",
      "state": "CA",
      "telephone_number": "805-577-8730"
    }
  ],
  "taxonomies": [
    {
      "code": "2085R0001X",
      "desc": null,
      "license": "G79330",
      "primary": true,
      "state": "CA",
      "taxonomy_group": "193400000X - Multiple Single Specialty 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 Allopathic & Osteopathic Physicians — Radiology, Radiation Oncology",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "92",
        "medicare_type": "Physician/Radiation Oncology"
      }
    ]
  }
}