{"npi":"1659833366","type":"NPI-1","status":"active","name":{"display":"Mateo Nicholson DO","other":[],"first":"MATEO","last":"NICHOLSON","middle":"F","credential":"DO"},"specialty":{"primary_taxonomy":"208100000X","primary_taxonomy_description":"Physical Medicine & Rehabilitation","slug":"physical-medicine-rehabilitation","schema_org_specialty":"Musculoskeletal","all":[{"code":"207R00000X","description":"Internal Medicine","primary":false,"state":"IL","license":"125074919"},{"code":"390200000X","description":"Student in an Organized Health Care Education/Training Program","primary":false,"state":"MN","license":"33866"},{"code":"390200000X","description":"Student in an Organized Health Care Education/Training Program","primary":false,"state":"WI","license":null},{"code":"208100000X","description":"Physical Medicine & Rehabilitation","primary":true,"state":"IN","license":"02007853A"},{"code":"390200000X","description":"Student in an Organized Health Care Education/Training Program","primary":false,"state":"WI","license":"75957-21"}]},"addresses":[{"purpose":"LOCATION","street_1":"2231 CAREW ST","city":"FORT WAYNE","state":"IN","postal_code":"468054713","country_code":"US","phone":"2604256780","fax":"2603739225"},{"purpose":"MAILING","street_1":"11109 PARKVIEW PLAZA DR # 117","city":"FORT WAYNE","state":"IN","postal_code":"468451701","country_code":"US"}],"license":{"state":"IN","number":"02007853A"},"identifiers":[],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20240821003832","type_code":"14-25","type_desc":"PRACTITIONER - PHYSICAL MEDICINE AND REHABILITATION","state":"IN","pac_id":"2668897687"}]},"enumeration_date":"2019-04-02","last_updated":"2024-10-02","_meta":{"source":"NPPES","snapshot_date":"2024-10-02","doc_url":"https://findmynpi.com/api"}}