{
  "npi": "1699178897",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "PA-C",
    "authorized_official_first_name": "RONNITA",
    "authorized_official_last_name": "HOLDEN",
    "authorized_official_name_prefix": "Mrs.",
    "authorized_official_telephone_number": "9198425566",
    "authorized_official_title_or_position": "Owner of Group",
    "certification_date": "2022-10-20",
    "enumeration_date": "2014-10-01",
    "last_updated": "2023-12-13",
    "organization_name": "BUFFALO LAKE MEDICAL, PLLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "181 MITTIE HADDOCK DR.",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "CAMERON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "919-375-2048",
      "postal_code": "28326",
      "state": "NC",
      "telephone_number": "919-842-5566"
    },
    {
      "address_1": "181 MITTIE HADDOCK DR.",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "CAMERON",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "919-375-2048",
      "postal_code": "28326",
      "state": "NC",
      "telephone_number": "919-842-5566"
    }
  ],
  "taxonomies": [
    {
      "code": "363A00000X",
      "desc": "Physician Assistant",
      "license": "197607",
      "primary": false,
      "state": "NC",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "261QR1100X",
      "desc": "Clinic/Center, Research",
      "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": []
  }
}