Active NPI
Peter Michael Blough, DDS
- Dentist
- Des Moines, IA
National Provider Identifier
1487093258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS-09131
- Practice address
- 1111 9TH St
Suite 190
Des Moines, IA 50314-2527 - Phone
- (515) 244-9136
- NPI assigned
- Jun 14, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS-09131 | IA | Primary |
| Dentist | 122300000X | 7114-15 | WI |
Addresses
Primary practice location
1111 9TH St
Suite 190
Des Moines, IA 50314-2527
Mailing address
1111 9TH St
Suite 190
Des Moines, IA 50314-2527
Phone (515) 244-9136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 29, 2021 through Dec 29, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS-09131 | IA | MD | Dentist |
| 7114-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415232000000",
"number": "1487093258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 9TH ST",
"address_2": "SUITE 190",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503142527",
"telephone_number": "515-244-9136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 9TH ST",
"address_2": "SUITE 190",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503142527",
"telephone_number": "515-244-9136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOUGH",
"first_name": "PETER",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-14",
"last_updated": "2014-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "DDS-09131",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "7114-15",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.