{
  "npi": "1730896291",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_first_name": "KYLE",
    "authorized_official_last_name": "DILLMAN",
    "authorized_official_telephone_number": "8124507399",
    "authorized_official_title_or_position": "Secretary Treasurer",
    "certification_date": "2023-01-26",
    "enumeration_date": "2022-11-03",
    "last_updated": "2023-01-26",
    "organization_name": "DEACONESS ILLINOIS SPECIALTY CLINIC, INC.",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1201 RICKER RD",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "SALEM",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "618-244-1926",
      "postal_code": "628814263",
      "state": "IL",
      "telephone_number": "182-418-7916"
    },
    {
      "address_1": "PO BOX 34266",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "BELFAST",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "812-450-6822",
      "postal_code": "049150620",
      "state": "ME",
      "telephone_number": "812-450-6815"
    }
  ],
  "taxonomies": [
    {
      "code": "363A00000X",
      "desc": "Physician Assistant",
      "license": null,
      "primary": false,
      "state": null,
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "207X00000X",
      "desc": "Orthopaedic Surgery",
      "license": null,
      "primary": true,
      "state": null,
      "taxonomy_group": "193200000X - Multi-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": "Board-Certified Orthopedic Surgeon (Bone, Joint, Spine & Sports Injury Surgeon)",
    "certifying_board": "American Board of Orthopaedic Surgery (ABOS)",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "02",
        "medicare_type": "Physician/General Surgery"
      },
      {
        "medicare_code": "20",
        "medicare_type": "Physician/Orthopedic Surgery"
      }
    ]
  }
}