{"npi":"1366427429","type":"NPI-1","status":"active","name":{"display":"Evan Provisor MD","other":[],"first":"EVAN","last":"PROVISOR","middle":"PAUL","credential":"MD"},"specialty":{"primary_taxonomy":"208600000X","primary_taxonomy_description":"Surgery","slug":"surgery","schema_org_specialty":"Surgical","all":[{"code":"208600000X","description":"Surgery","primary":true,"state":"MA","license":"237945"}]},"addresses":[{"purpose":"LOCATION","street_1":"94 SOUTH ST","city":"SOUTHBRIDGE","state":"MA","postal_code":"015504000","country_code":"US","phone":"5087646966","fax":"5087642457"},{"purpose":"MAILING","street_1":"94 SOUTH ST","city":"SOUTHBRIDGE","state":"MA","postal_code":"015504000","country_code":"US","phone":"5087646966","fax":"5087642457"}],"license":{"state":"MA","number":"237945"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"2160307","state":"MA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20081017000114","type_code":"14-02","type_desc":"PRACTITIONER - GENERAL SURGERY","state":"MA","pac_id":"8022045947"}]},"enumeration_date":"2005-12-13","last_updated":"2011-12-21","_meta":{"source":"NPPES","snapshot_date":"2011-12-21","doc_url":"https://findmynpi.com/api"}}