{
  "npi": "1720567241",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "KIM",
    "authorized_official_last_name": "HARRIS",
    "authorized_official_telephone_number": "3044482101",
    "authorized_official_title_or_position": "Credentialing/Billing Coord.",
    "enumeration_date": "2018-08-07",
    "last_updated": "2018-08-07",
    "organization_name": "TUG RIVER HEALTH ASSOCIATION, INC.",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "RR 103 SUPPLY STREET",
      "address_2": "PO BOX 507",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "GARY",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "304-448-3217",
      "postal_code": "24836",
      "state": "WV",
      "telephone_number": "304-448-2101"
    },
    {
      "address_1": "512 MOUNTAINEEER HIGHWAY",
      "address_2": "ROOM 1344",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "BRADSHAW",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "248742487",
      "state": "WV",
      "telephone_number": "304-967-7684"
    }
  ],
  "taxonomies": [
    {
      "code": "291U00000X",
      "desc": "Clinical Medical Laboratory",
      "license": "51D1064007",
      "primary": true,
      "state": "WV",
      "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": "CLIA-Certified Diagnostic Medical & Pathology Laboratory",
    "certifying_board": "CMS CLIA / College of American Pathologists (CAP)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "69",
        "medicare_type": "Clinical Laboratory"
      },
      {
        "medicare_code": "B4[14]",
        "medicare_type": "Histocompatibility Laboratory"
      }
    ]
  }
}