Richard T Pruiksma, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-0221 Issued in AR

Practice address

500 S Mount Olive St
Suite 200
Siloam Springs, AR 72761-3602

Phone

(479) 524-9550

Fax

(479) 524-9552

NPI assigned

Jun 22, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prairie Band Potawatomi Nation

  • Federally Qualified Health Center (FQHC)
  • Mayetta, KS
  • NPI 1245266410
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1053357491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 E EMMA AVENUE",
            "address_2": "SUITE 300",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727644469",
            "telephone_number": "479-751-7417",
            "fax_number": "479-751-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S MOUNT OLIVE ST",
            "address_2": "SUITE 200",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727613602",
            "telephone_number": "479-524-9550",
            "fax_number": "479-524-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUIKSMA",
        "first_name": "RICHARD",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "20107",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-28209",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-0221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "351793",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "E-0221",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Matthew Plummer, LCSW
• Lindsay A Pool, LCSW
• Dana Posey, LPC
• Abby Poteet, MS, LPC
• Premier Family Health Care LLC
• Psychiatry of Texas PLLC
• Psychplus Medical Associates PLLC
• Pulse Emergency Medical Services
• Erin Raber, PHARMD
• Rachael Nachtigal, PLLC

• Family Medicine Physician in Siloam Springs, AR
• Providers in Siloam Springs, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.