NPIMap

Organization Active NPI

Peter Grotuss MD PC

Doing business as Roaring Fork Dermatology

  • Dermatology Physician
  • Basalt, CO
National Provider Identifier
1346384369
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20541 Issued in CO
Legal business name
PETER GROTUSS MD PC
Doing business as
Roaring Fork Dermatology
Practice address
23262 Two Rivers Rd
Basalt, CO 81621-9227
Phone
(970) 927-4731
Fax
(970) 927-4420
NPI assigned
Feb 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Julian Ramsey Mellette, MD
Title
Director
Phone
(970) 927-4731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 20541 CO Primary

Addresses

Primary practice location

23262 Two Rivers Rd
Basalt, CO 81621-9227

Mailing address

PO Box 1489
Basalt, CO 81621-1489
Phone (970) 927-4731

Other names 1

  • ROARING FORK DERMATOLOGY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346384369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1489",
            "city": "BASALT",
            "state": "CO",
            "postal_code": "816211489",
            "telephone_number": "970-927-4731",
            "fax_number": "970-927-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23262 TWO RIVERS RD",
            "city": "BASALT",
            "state": "CO",
            "postal_code": "816219227",
            "telephone_number": "970-927-4731",
            "fax_number": "970-927-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER GROTUSS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MELLETTE",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_middle_name": "RAMSEY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "970-927-4731",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "20541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROARING FORK DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Basalt, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.