{
  "npi": "1881909935",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "M.D.",
    "authorized_official_first_name": "JERALD",
    "authorized_official_last_name": "COOPER",
    "authorized_official_middle_name": "L.",
    "authorized_official_name_prefix": "--",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2604368686",
    "authorized_official_title_or_position": "M.D./President",
    "enumeration_date": "2010-08-13",
    "last_updated": "2013-11-27",
    "organization_name": "FORT WAYNE ORTHOPEDICS, LLC",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 2526",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "FORT WAYNE",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "260-432-5075",
      "postal_code": "468012526",
      "state": "IN",
      "telephone_number": "260-436-8686"
    },
    {
      "address_1": "207 N TOWNLINE RD",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "LAGRANGE",
      "country_code": "US",
      "country_name": "United States",
      "fax_number": "260-459-0036",
      "postal_code": "467611325",
      "state": "IN",
      "telephone_number": "260-436-8686"
    }
  ],
  "taxonomies": [
    {
      "code": "207XS0106X",
      "desc": "Orthopaedic Surgery, Hand Surgery",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "207XS0117X",
      "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "207XX0005X",
      "desc": "Orthopaedic Surgery, Sports Medicine",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "207XX0801X",
      "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "213E00000X",
      "desc": "Podiatrist",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "213ES0131X",
      "desc": null,
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "363A00000X",
      "desc": "Physician Assistant",
      "license": "50002482",
      "primary": false,
      "state": "IN",
      "taxonomy_group": "193200000X - Multi-Specialty Group"
    },
    {
      "code": "207X00000X",
      "desc": "Orthopaedic Surgery",
      "license": "50002482",
      "primary": true,
      "state": "IN",
      "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"
      }
    ]
  }
}