{
  "npi": "1679172993",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "PTA",
    "authorized_official_first_name": "VICTORIA",
    "authorized_official_last_name": "ALVARADO",
    "authorized_official_name_prefix": "Miss",
    "authorized_official_telephone_number": "4058453389",
    "authorized_official_title_or_position": "Owner/PTA",
    "certification_date": "2021-04-07",
    "enumeration_date": "2020-10-19",
    "last_updated": "2021-04-07",
    "organization_name": "ABC PEDIATRIC REHAB LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "508 W I 240 SERVICE RD",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "OKLAHOMA CITY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "405-724-9617",
      "postal_code": "731394400",
      "state": "OK",
      "telephone_number": "405-724-9303"
    },
    {
      "address_1": "1808 DOROTHY DR",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "MOORE",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "731701457",
      "state": "OK",
      "telephone_number": "405-570-2672"
    }
  ],
  "taxonomies": [
    {
      "code": "2080S0010X",
      "desc": "Pediatrics, Sports Medicine",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "2251P0200X",
      "desc": "Physical Therapist, Pediatrics",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "225200000X",
      "desc": "Physical Therapy Assistant",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "225700000X",
      "desc": "Massage Therapist",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "261QP2000X",
      "desc": "Clinic/Center, Physical Therapy",
      "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": [
      {
        "medicare_code": "70",
        "medicare_type": "Clinic or Group Practice"
      }
    ]
  }
}