Peter G Roan, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

M-6613 Issued in ID

Practice address

207 1St St S
Nampa, ID 83651-3703

Phone

(208) 466-7869

Fax

(208) 466-5359

NPI assigned

Oct 21, 2005

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 4

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional Cardiology

Education

University of Michigan Medical School, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Clinics IncGroup PAC ID 4082527353, shared by 17 NPIs, 75 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: proan821872@direct.ochin.org
• Direct secure messaging: proan1564146@direct.trinity-health.org

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.

• Community Health Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Nampa, ID
  • NPI 1457309122
  Medicare reassignment NPD
• Community Health Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Caldwell, ID
  • NPI 1043230501
  NPD
• Community Health Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Boise, ID
  • NPI 1346254026
  NPD
• Mercy Physician Group Inc.

  • Adult Medicine Physician
  • Nampa, ID
  • NPI 1104972983

  Cardiovascular Disease

  NPD (past)

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1326037342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 E RIVERNEST LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066928",
            "telephone_number": "208-869-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 1ST ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513703",
            "telephone_number": "208-466-7869",
            "fax_number": "208-466-5359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4424 E Flamingo Ave",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836879306",
            "country_code": "US",
            "telephone_number": "208-302-0200",
            "fax_number": "208-302-0255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROAN",
        "first_name": "PETER",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "M6613",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "ID",
            "license": "M-6613",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ID",
            "license": "M-6613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00182709",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003895300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010149232",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B3390",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Lawrence Ripplinger, DDS
• Rising Hope Counseling Services, LLC
• Bonnie Alaine Walser Rivas, CNM
• Mary E River, MD
• Erika Lynn Rivera, LMSW
• Bette Robbins, RPH
• Jeffrey Roberts, LPN,WCN
• John Aaron Roberts, PHARMD
• Rick N. Roberts, M.D.
• Steve Edward Roberts, MD

• Cardiovascular Disease Physician in Nampa, ID
• Providers in Nampa, ID by specialty
• Cardiovascular Disease Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; 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.
• 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.