{
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  "enumeration_type": "NPI-1",
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    "credential": "PA-C",
    "enumeration_date": "2017-08-31",
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    "last_updated": "2025-12-01",
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      "address_1": "PO BOX 959203",
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      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
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  "medicare_utilization": null,
  "enrichment": {
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    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
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}