{% load static %} {% get_static_prefix as STATIC_PREFIX %} {{enumeration.basic.first_name}} {{enumeration.basic.last_name}} {{enumeration.basic.organization_name}}


{{ 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}} {% 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

{%if enumeration.enumeration_type == 'NPI-2' %} {% endif %} {% if enumeration.specialty %} {% endif %}
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 {% for i in enumeration.identifiers %} {% endfor %}
Issuer Number State
{{i.code}} {{i.identifier}} {{i.state}}

NOTE: This may not be the address you are seeking. Health care providers often practice at multiple locations. CMS may not have the latest information on file within NPPES.