Devin Daniel Rourke, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-5105 Issued in ID

Practice address

1090 W Park PL Ste B
Coeur D Alene, ID 83814-2785

Phone

(082) 920-6972

Fax

(208) 292-0357

NPI assigned

Jul 6, 2019

Last updated

Jul 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1316509755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1387",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838351387",
            "telephone_number": "208-415-0299",
            "fax_number": "208-625-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 W PARK PL STE B",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142785",
            "telephone_number": "082-920-6972",
            "fax_number": "208-292-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROURKE",
        "first_name": "DEVIN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-06",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Rossberg, COTA/L
• Shawna Rossberg, COTA
• Louise Frances Rossi, MA-CCC-SLP
• Roger J. Roth, D.M.D.
• Rebecca McKayl Rothie
• Teri Renee Rouse, FNP-C
• Robin Rowland, OTRL
• Luann Roy, NMD
• Tina Marie Rozniewski, CPSS
• RSL Renaissance, LLC (The Renaissance at Coeur D'Alene)

• General Practice Dentistry in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.