Individual provider Active NPI

Bernard N Raasch, M.D.

  • Diagnostic Radiology Physician
  • Liverpool, NY
National Provider Identifier
1508858408
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
133776 Issued in NY
Practice address
5100 W Taft Rd
Suite 2a
Liverpool, NY 13088-3807
Phone
(315) 452-2555
Fax
(315) 452-2559
NPI assigned
Aug 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 133776 NY Primary

Addresses

Primary practice location

5100 W Taft Rd
Suite 2a
Liverpool, NY 13088-3807

Mailing address

4567 Crossroads Park Dr
2ND Floor
Liverpool, NY 13088-3589
Phone (315) 295-2100

Other identifiers 4

IdentifierTypeStateIssuer
00482233MedicaidNY
00555440MedicaidNY
00555500MedicaidNY
02224500MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20091231000048 NY Practitioner - Diagnostic Radiology 7618872078 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
133776NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Radiology Associates, LLP Diagnostic Radiology CurrentSince Oct 1, 2015 Accepting new patients
Mohawk Glen Radiology Associates of Cny PLLC Diagnostic Radiology PastSince May 2, 2011 Accepting new patients
Central New York Pet LLC PastSince Sep 19, 2001 Accepting new patients
St. Josephs Imaging Associates PLLC Diagnostic Radiology PastSince Aug 1, 1996 Accepting new patients
Prospect Hill Radiology Group P C Diagnostic Radiology Past Accepting new patients

Locations

224 Harrison St
Ste 601
Syracuse, NY 13202
Phone (315) 464-6672

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

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.

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189641600000",
    "number": "1508858408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4567 CROSSROADS PARK DR",
            "address_2": "2ND FLOOR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883589",
            "telephone_number": "315-295-2100",
            "fax_number": "315-295-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 2A",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2555",
            "fax_number": "315-452-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAASCH",
        "first_name": "BERNARD",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2007-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "133776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00482233",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00555440",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00555500",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02224500",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.