Individual provider Active NPI

Robert T Raster, MD

  • Psychiatry Physician
  • South Bend, IN
National Provider Identifier
1417924879
Registry record updated Nov 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01045140 Issued in IN
Practice address
403 E Madison St
South Bend, IN 46617-2322
Phone
(574) 234-0061
Fax
(574) 283-1209
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 01045140 IN Primary

Addresses

Primary practice location

403 E Madison St
South Bend, IN 46617-2322

Mailing address

403 E Madison St
South Bend, IN 46617-2322
Phone (574) 234-0061

Other identifiers 1

IdentifierTypeStateIssuer
200103420AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091210000098 IN Practitioner - Psychiatry 1850430547 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Wayne State University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Bend Psychiatry LLCGroup PAC ID 1951440643, 3 clinicians

Practice addresses (Care Compare)

1800 N Oak Dr
Plymouth, IN 46563-3406
Phone (574) 303-5375

221 Red Coach Dr E
Behavioral Health
Mishawaka, IN 46545-8324
Phone (574) 335-7630

301 W Homer St
Michigan City, IN 46360-4358
Phone (219) 879-8511

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01045140INMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Joseph Regional Medical Center, Inc. Psychiatry CurrentSince Nov 1, 2023 Accepting new patients
Saint Joseph Regional Medical Center, Inc. CurrentSince Nov 1, 2023 Accepting new patients
South Bend Psychiatry LLC Psychiatry CurrentSince Nov 1, 2009 Accepting new patients
HHC Indiana Inc. Past Accepting new patients
Aims-Med, LLC PastSince Sep 17, 2023 Accepting new patients

Locations

1012 W Indiana St
Kouts, IN 46347
Phone (219) 766-2999

301 W Homer St
Michigan City, IN 46360
Phone (219) 877-1033

60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232

221 Red Coach Dr
Ste E
Mishawaka, IN 46545
Phone (574) 335-7630

1800 N Oak Dr
Plymouth, IN 46563
Phone (574) 303-5375

2349 Lake Ave
Ste 100
Plymouth, IN 46563
Phone (574) 941-3111

403 E Madison St
South Bend, IN 46617
Phone (574) 234-0061

616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100

Interoperability endpoints

  • Direct secure messaging: rraster1147644@direct.trinity-health.org
  • Direct secure messaging: rraster171465@direct.franciscanalliance.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257120000000",
    "number": "1417924879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 E MADISON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172322",
            "telephone_number": "574-234-0061",
            "fax_number": "574-283-1209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 E MADISON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172322",
            "telephone_number": "574-234-0061",
            "fax_number": "574-283-1209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASTER",
        "first_name": "ROBERT",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2009-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01045140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200103420A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.