{"npi":"1962437400","type":"NPI-1","status":"active","name":{"display":"Lynn Squanda DO","other":[{"code":"1","type":"Formerly known as","value":"SQUANDA, LYNN MARIE"}],"first":"LYNN","last":"SQUANDA","middle":"MARIE","credential":"DO"},"specialty":{"primary_taxonomy":"207Q00000X","primary_taxonomy_description":"Family Medicine","slug":"family-medicine","schema_org_specialty":"PrimaryCare","all":[{"code":"207Q00000X","description":"Family Medicine","primary":true,"state":"MI","license":"5101013512"}]},"addresses":[{"purpose":"LOCATION","street_1":"1140 N STATE ST","city":"SAINT IGNACE","state":"MI","postal_code":"497811048","country_code":"US","phone":"9066438689","fax":"9066434165"},{"purpose":"MAILING","street_1":"524 S COURT AVE","city":"GAYLORD","state":"MI","postal_code":"497351215","country_code":"US","phone":"9893504105"}],"license":{"state":"MI","number":"5101013512"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"4547432","state":"MI","issuer":null},{"type_code":"01","label":"Other","value":"0156910035","state":"MI","issuer":"BCBSM PROVIDER NUMBER"},{"type_code":"01","label":"Other","value":"381303843","state":null,"issuer":"TAX ID"},{"type_code":"01","label":"Other","value":"CC4805","state":null,"issuer":"MEDICARE RR PROV ID"},{"type_code":"01","label":"Other","value":"11289516","state":null,"issuer":"CAQH PROVIDER ID"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20031209001079","type_code":"14-08","type_desc":"PRACTITIONER - FAMILY PRACTICE","state":"MI","pac_id":"0840196903"}]},"enumeration_date":"2006-07-12","last_updated":"2024-12-31","_meta":{"source":"NPPES","snapshot_date":"2024-12-31","doc_url":"https://findmynpi.com/api"}}