{
  "npi": "1730705989",
  "enumeration_type": "NPI-1",
  "basic": {
    "certification_date": "2026-10-30",
    "credential": "NP",
    "enumeration_date": "2020-06-23",
    "first_name": "DAVID",
    "last_name": "BALDERSON",
    "last_updated": "2026-10-30",
    "middle_name": "BRIAN",
    "sex": "M",
    "sole_proprietor": "YES",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "2001 RIVER VIEW AVE TRLR 88",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "STEVENS POINT",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "544815278",
      "state": "WI",
      "telephone_number": "715-540-0069"
    },
    {
      "address_1": "2001 RIVER VIEW AVE TRLR 88",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "STEVENS POINT",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "544815278",
      "state": "WI",
      "telephone_number": "715-540-0069"
    }
  ],
  "taxonomies": [
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "243896",
      "primary": false,
      "state": "MT",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "202155",
      "primary": false,
      "state": "SD",
      "taxonomy_group": ""
    },
    {
      "code": "363L00000X",
      "desc": "Nurse Practitioner",
      "license": "14275618-4405",
      "primary": false,
      "state": "UT",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "38820",
      "primary": false,
      "state": "TN",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "CNP261391",
      "primary": false,
      "state": "ME",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "9884-33",
      "primary": true,
      "state": "WI",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "2025008147",
      "primary": false,
      "state": "MO",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "4704420389",
      "primary": false,
      "state": "MI",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "61611209",
      "primary": false,
      "state": "WA",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "A184177",
      "primary": false,
      "state": "IA",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "55551",
      "primary": false,
      "state": "WY",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "71015843A",
      "primary": false,
      "state": "IN",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "F356963-01",
      "primary": false,
      "state": "NY",
      "taxonomy_group": ""
    },
    {
      "code": "363LF0000X",
      "desc": "Nurse Practitioner, Family",
      "license": "0024191927",
      "primary": false,
      "state": "VA",
      "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 & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "50",
        "medicare_type": "Nurse Practitioner"
      }
    ]
  }
}