{{ enumeration.basic.name_prefix}} {{enumeration.basic.first_name}} {{enumeration.basic.middle_name}} {{enumeration.basic.last_name}} {{enumeration.basic.organization_name}}{{enumeration.basic.name_suffix}} {% if enumeration.basic.credential %} {{enumeration.basic.credential }}{% endif %}
{%if enumeration.enumeration_type == 'NPI-1' %} Gender: {%if enumeration.basic.gender == 'M' %} MALE {%else%} FEMALE {% endif %}
Sole Proprietor: {{ enumeration.basic.sole_proprietor}}
Medicare Provider: {%if pecos %} YES {% else %} NO {% endif %} {% endif %} {% if enumeration.bio_headline %}{{enumeration.bio_headline}}{% endif %}
{{enumeration.enumeration_type}}: {{enumeration.number}}
{%if enumeration.basic.website %}
{{enumeration.basic.website}}
{% endif %}
Last Updated: {{enumeration.basic.last_updated}}
Summary
Name | Value | ||||||
---|---|---|---|---|---|---|---|
Enumeration Number | {{enumeration.number}} ({{enumeration.enumeration_type}}) | ||||||
Enumeration Date | {{enumeration.basic.enumeration_date}} | ||||||
Entity Type | {%if enumeration.enumeration_type == 'NPI-1' %} 1 - Individual {% else%} 2- Organization {% endif %} | ||||||
Authorized Official Information |
Name: {{enumeration.basic.authorized_official_name_prefix}}
{{enumeration.basic.authorized_official_first_name}}
{{enumeration.basic.authorized_official_middle_name}}
{{enumeration.basic.authorized_official_last_name}}
{{enumeration.basic.authorized_official_credential}}
Title: {{enumeration.basic.authorized_official_title_or_position}} Phone: {{enumeration.basic.authorized_official_telephone_number}} |
||||||
Status | {% if enumeration.basic.status == "A" %} Active {% else%} Deactive {% endif %} | ||||||
Specialty | {{enumeration.specialty}} | ||||||
Licenses | {% for l in enumeration.licenses %} State: {{l.state}} License Number: {{l.code}} {% endfor %} | ||||||
Mailing Address | {% for a in enumeration.addresses %}
{% if a.address_purpose == "MAILING"%}
{{a.address_1}}
{{a.address_2}}
{{a.city}}, {{a.state}} {{a.zip}} Phone: {{a.us_telephone_number}} | Fax: {{a.us_fax_number}} {% endif %} {% endfor %} |
||||||
Primary Practice Address | {% for a in enumeration.addresses %}
{% if a.address_purpose == "LOCATION"%}
{{a.address_1}}
{{a.address_2}}
{{a.city}}, {{a.state}} {{a.zip}} Phone: {{a.us_telephone_number}} | Fax: {{a.us_fax_number}} {% endif %} {% endfor %} |
||||||
Taxonomy |
{% for t in enumeration.taxonomies %}
{% if t.primary %}
{{t.code}} - {{t.desc}} (Primary) {% endif %} {% endfor %} {% for t in enumeration.taxonomies %} {% if not t.primary %} {{t.code}} - {{t.desc}} {% endif %} {% endfor %} |
||||||
Other Identifiers |
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