{"npi":"1306093463","type":"NPI-2","status":"active","name":{"display":"Custom Medical Equipment LLC","other":[],"organization_name":"CUSTOM MEDICAL EQUIPMENT LLC","authorised_official":"Josephine Czerny"},"specialty":{"primary_taxonomy":"332BC3200X","primary_taxonomy_description":"Customized Equipment (DME)","slug":"customized-equipment-dme","schema_org_specialty":null,"all":[{"code":"332BC3200X","description":"Customized Equipment (DME)","primary":true,"state":"MN","license":"9615269"}]},"addresses":[{"purpose":"LOCATION","street_1":"1001 S POKEGAMA AVE STE A","city":"GRAND RAPIDS","state":"MN","postal_code":"557443919","country_code":"US","phone":"2183262212"},{"purpose":"MAILING","street_1":"1001 S POKEGAMA AVE STE A","city":"GRAND RAPIDS","state":"MN","postal_code":"557443919","country_code":"US","phone":"2183262212"}],"license":{"state":"MN","number":"9615269"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"697697100","state":"MN","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100930071897","type_code":"30-54","type_desc":"DME SUPPLIER - MEDICAL SUPPLY COMPANY","state":"MN","pac_id":"0648477851"}]},"enumeration_date":"2008-08-20","last_updated":"2022-08-19","_meta":{"source":"NPPES","snapshot_date":"2022-08-19","doc_url":"https://findmynpi.com/api"}}