Ruth Peterka

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12830 Issued in MN

Practice address

412 Lake Avenue North
Battle Lake, MN 56515

Phone

(218) 371-7100

NPI assigned

Jul 27, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280188800000",
    "number": "1619281177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 332",
            "city": "BATTLE LAKE",
            "state": "MN",
            "postal_code": "565150332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 LAKE AVENUE NORTH",
            "city": "BATTLE LAKE",
            "state": "MN",
            "postal_code": "56515",
            "telephone_number": "218-371-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERKA",
        "first_name": "RUTH",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2010-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Rae Koppang, MS CCCSLP
• Kelly Ann Kruschke, DNP, FNP-BC, RN
• Midwest Community Residential Services, Inc.
• Jay Harvey Olson
• Otter Tail County
• Amanda Roberts
• Seip Drug LLC
• Serenity Lakes Home Care
• Todd S Smith, DDS
• Steve & Barb Jensen

• General Practice Dentistry in Battle Lake, MN
• Providers in Battle Lake, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2010; 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.