{
  "npi": "1689897209",
  "enumeration_type": "NPI-1",
  "basic": {
    "credential": "PAC",
    "enumeration_date": "2007-04-11",
    "first_name": "WANDLE",
    "last_name": "BUTLER",
    "last_updated": "2016-11-09",
    "middle_name": "KEITH",
    "name_prefix": "Mr.",
    "name_suffix": "--",
    "sex": "M",
    "sole_proprietor": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "306 WESTSIDE DR",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "DOUGLAS",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "912-383-7299",
      "postal_code": "315333530",
      "state": "GA",
      "telephone_number": "912-383-7826"
    },
    {
      "address_1": "410 SHIRLEY AVE",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "DOUGLAS",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "912-383-7820",
      "postal_code": "315332002",
      "state": "GA",
      "telephone_number": "912-260-1206"
    }
  ],
  "taxonomies": [
    {
      "code": "363A00000X",
      "desc": "Physician Assistant",
      "license": "003196",
      "primary": true,
      "state": "GA",
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": true,
      "status": "EXCLUDED",
      "matches": [
        {
          "name": "WANDLE KEITH BUTLER",
          "npi": "1689897209",
          "specialty": "PHYSICIAN ASSISTANT",
          "city": "JESUP",
          "state": "GA",
          "excl_type": "1128a4",
          "excl_date": "2023-05-18",
          "statute_desc": "Sec. 1128(a)(4) — Felony Controlled Substance Conviction"
        }
      ],
      "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 Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "97",
        "medicare_type": "Physician Assistant"
      }
    ]
  }
}