{
  "npi": "1679747588",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "D.D.S",
    "authorized_official_first_name": "RANDY",
    "authorized_official_last_name": "SMITH",
    "authorized_official_middle_name": "G.",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2085421333",
    "authorized_official_title_or_position": "Owner",
    "enumeration_date": "2008-04-22",
    "last_updated": "2024-04-08",
    "organization_name": "ALLIGATOR PEDIATRIC DENTISTRY ,PLLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "2805 EAGLE DRIVE",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "AMMON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "208-552-7296",
      "postal_code": "83406",
      "state": "ID",
      "telephone_number": "208-542-1333"
    },
    {
      "address_1": "2805 EAGLE DRIVE",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "AMMON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "208-552-7296",
      "postal_code": "83406",
      "state": "ID",
      "telephone_number": "208-542-1333"
    }
  ],
  "taxonomies": [
    {
      "code": "1223P0221X",
      "desc": "Dentist, Pediatric Dentistry",
      "license": "D3257PD",
      "primary": true,
      "state": "ID",
      "taxonomy_group": "193400000X - 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 Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)",
    "certifying_board": "American Dental Association (ADA) / State Board of Dental Examiners",
    "cms_medicare_crosswalk": []
  }
}