NPIMap

Organization Active NPI

Racc Medical Associates LLC

  • Physical Medicine & Rehabilitation Physician
  • Fort Wayne, IN
National Provider Identifier
1184976136
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
RACC MEDICAL ASSOCIATES LLC
Practice address
1721 Magnavox Way
Fort Wayne, IN 46804-1537
Phone
(260) 748-3650
Fax
(260) 748-3651
NPI assigned
Oct 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Daniel C Roth, DONPI 1861687923
Title
Owner
Phone
(260) 748-3650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1721 Magnavox Way
Fort Wayne, IN 46804-1537

Mailing address

1721 Magnavox Way
Ste B
Fort Wayne, IN 46804-1537
Phone (260) 748-3650

Other practice location 1

6811 Lima Rd
Fort Wayne, IN 46818-1145
Phone (260) 748-3650

Other practice location 2

1314 E 7th St Ste 201
Auburn, IN 46706-2533
Phone (260) 748-3650

Other practice location 3

330 N Wabash Ave Ste 410
Marion, IN 46952-2782
Phone (260) 748-3650

Other practice location 4

2124 Biomet Drive
Warsaw, IN 46582-7858
Phone (260) 748-3650

Other identifiers 1

IdentifierTypeStateIssuer
300038645MedicaidIN

Other names 1

  • Summit Pain Management Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130209000024 IN Part B Supplier - Clinic/Group Practice 0648424127 Receives reassigned benefits from 26 practitioners
Practice locations: Warsaw, IN; Wabash, IN; Marion, IN; Kendalville, IN; Fort Wayne, IN; Huntington, IN; Auburn, IN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2066048Summit Pain Management1721 Magnavox Way Suite B, Fort Wayne, IN 46804ComplianceJan 15, 2028

National Provider Directory

National Provider Directory

Locations

1314 E 7th St
Ste A
Auburn, IN 46706

1314 E 7th St
Auburn, IN 46706
Phone (260) 925-8000

303 S Main St
#2
Bluffton, IN 46714

10319 Dawsons Creek Blvd
Fort Wayne, IN 46825

1721 Magnavox Way
Ste Ab
Fort Wayne, IN 46804

10319 Dawsons Creek Blvd
Ste F
Fort Wayne, IN 46825

1721 Magnavox Way
Fort Wayne, IN 46804
Phone (260) 250-0001

2512 E DuPont Rd
Ste 200
Fort Wayne, IN 46825
Phone (260) 458-3760

6811 Lima Rd
Fort Wayne, IN 46818
Phone (260) 969-2323

1721 Magnavox Way
Ste 100
Fort Wayne, IN 46804

2855 Northpark Ave
Ste 105
Huntington, IN 46750

2855 Northpark Ave
Ste 106
Huntington, IN 46750

519 Professional Way
Kendallville, IN 46755
Phone (260) 347-3770

330 N Wabash Ave
Ste 401
Marion, IN 46952

2716 S Western Ave
Ste D
Marion, IN 46953

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1184976136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 MAGNAVOX WAY",
            "address_2": "STE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041537",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 MAGNAVOX WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041537",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6811 Lima Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468181145",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1314 E 7th St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "IN",
            "postal_code": "467062533",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "330 N Wabash Ave Ste 410",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IN",
            "postal_code": "469522782",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2124 Biomet Drive",
            "address_purpose": "LOCATION",
            "city": "Warsaw",
            "state": "IN",
            "postal_code": "465827858",
            "country_code": "US",
            "telephone_number": "260-748-3650",
            "fax_number": "260-748-3651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RACC MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-748-3650",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300038645",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.