Indra Soerja Oetomo, PT, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

978 Issued in CO

Practice address

8955 S Ridgeline Blvd
Suite 400
Highlands Ranch, CO 80129-2362

Phone

(303) 683-8338

Fax

(303) 683-8809

NPI assigned

Apr 28, 2006

Last updated

Sep 11, 2025By 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 2

Addresses

Other names 1

• Mr. Rory Oetomo Professional name

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Meromed Physiotherapy Centre, LLC

  • Acupuncturist
  • Highlands Ranch, CO
  • NPI 1902983950
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1326005745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8955 S RIDGELINE BLVD",
            "address_2": "SUITE 400",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292362",
            "telephone_number": "303-683-8338",
            "fax_number": "303-683-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8955 S RIDGELINE BLVD",
            "address_2": "SUITE 400",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292362",
            "telephone_number": "303-683-8338",
            "fax_number": "303-683-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OETOMO",
        "first_name": "INDRA",
        "middle_name": "SOERJA",
        "name_prefix": "Mr.",
        "credential": "PT, LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CO",
            "license": "978",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CO",
            "license": "3579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RORY",
            "last_name": "OETOMO",
            "prefix": "MR.",
            "credential": "PT, LAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Oak Tree Behavioral Services
• OB-GYN Affiliates
• Occupational Health Centers of the Southwest P.a. (Concentra Medical Center)
• Rosa Yamil Ochoa Andujo, RDN
• Nia Odollil, PHARMD
• Breanna Thanh Olden, OTR/L
• Veronica Alyse Olesen, LCSW
• Kristen Olguin
• Margaret Grace Oliver Dods, MD
• Christopher L Oliver, MD

• Acupuncturist in Highlands Ranch, CO
• Providers in Highlands Ranch, CO by specialty
• Acupuncturist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.