Peter James Roukema, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10054 Issued in CO

Practice address

228 Village Dr
Pagosa Springs, CO 81147-8308

Phone

(970) 731-2126

NPI assigned

Apr 14, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

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 and National Provider Directory roles.

• Pagosa Peak Family Dentistry, PLLC

  • Dental Clinic/Center
  • Pagosa Springs, CO
  • NPI 1184377392
  NPD Authorized official

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1457525263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HAREBELL DR",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811477721",
            "telephone_number": "216-374-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 VILLAGE DR",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478308",
            "telephone_number": "970-731-2126"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 Central Ave SW",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871052033",
            "country_code": "US",
            "telephone_number": "505-836-0322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUKEMA",
        "first_name": "PETER",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2022-02-04",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3069",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "10054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Thomas Reynolds, D.O.
• Brandy Diane Richardson, CLC
• Erica J Robinson
• Rocky Mountain Physical Therapy & Sports Injury Center, Inc.
• Merenda Renae Romine, LMT
• J Glenn Rutherford, DDS
• Jordan G Rutherford
• Kristin L Salisbury, OCCUPATIONAL THERAP
• San Juan Dental Hygiene LLC
• San Juan Dental LLC

• General Practice Dentistry in Pagosa Springs, CO
• Providers in Pagosa Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.