{
  "npi": "1750551818",
  "enumeration_type": "NPI-1",
  "basic": {
    "credential": "PA",
    "enumeration_date": "2008-03-05",
    "first_name": "SOTHEARY",
    "last_name": "CHAN",
    "last_updated": "2008-03-05",
    "name_prefix": "--",
    "name_suffix": "--",
    "sex": "M",
    "sole_proprietor": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 218",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "FAIRFAX",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "803-632-2410",
      "postal_code": "298270218",
      "state": "SC",
      "telephone_number": "803-632-1176"
    },
    {
      "address_1": "1787 ALLENDALE FAIRFAX HWY",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "FAIRFAX",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "803-632-2410",
      "postal_code": "298279133",
      "state": "SC",
      "telephone_number": "803-632-1176"
    }
  ],
  "taxonomies": [
    {
      "code": "363AM0700X",
      "desc": "Physician Assistant, Medical",
      "license": "1272",
      "primary": true,
      "state": "SC",
      "taxonomy_group": ""
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": true,
      "status": "EXCLUDED",
      "matches": [
        {
          "name": "SOTHEARY CHAN",
          "npi": "1750551818",
          "specialty": "PHYSICIAN ASSISTANT",
          "city": "BARNWELL",
          "state": "SC",
          "excl_type": "1128b1",
          "excl_date": "2011-12-20",
          "statute_desc": "Social Security Act 1128b1"
        }
      ],
      "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, Medical",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "97",
        "medicare_type": "Physician Assistant"
      }
    ]
  }
}