{
  "npi": "1780923110",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "CSFA",
    "authorized_official_first_name": "GARY",
    "authorized_official_last_name": "SLATER",
    "authorized_official_middle_name": "W",
    "authorized_official_name_prefix": "Mr.",
    "authorized_official_name_suffix": "III",
    "authorized_official_telephone_number": "7272047315",
    "authorized_official_title_or_position": "Certified Surgical First Assist",
    "certification_date": "2024-05-21",
    "enumeration_date": "2013-02-05",
    "last_updated": "2024-05-21",
    "organization_name": "ADVANCED SURGICAL EVOLUTIONS",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "1141 PALM BLVD",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "DUNEDIN",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "346982237",
      "state": "FL",
      "telephone_number": "727-204-7315"
    },
    {
      "address_1": "PO BOX 1142",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "DUNEDIN",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "346971142",
      "state": "FL",
      "telephone_number": "727-204-7315"
    }
  ],
  "taxonomies": [
    {
      "code": "246ZC0007X",
      "desc": "Specialist/Technologist, Other, Surgical Assistant",
      "license": "129713",
      "primary": false,
      "state": "FL",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "363AS0400X",
      "desc": "Physician Assistant, Surgical",
      "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": "Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "97",
        "medicare_type": "Physician Assistant"
      }
    ]
  }
}