Active NPI
Robert J. Hruskovich, MD
- Family Medicine Physician
- South Bend, IN
National Provider Identifier
1720078108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01043972A
- Practice address
- 211 N Eddy St.
South Bend, IN 46617-3096 - Phone
- (574) 246-8816
- Fax
- (574) 204-6345
- NPI assigned
- Oct 26, 2005
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 52696 | SC | |
| Family Medicine Physician | 207Q00000X | 4301116232 | MI | |
| Family Medicine Physician | 207Q00000X | MD046481 | DC | |
| Family Medicine Physician | 207Q00000X | 15405 | ND | |
| Family Medicine Physician | 207Q00000X | R9778 | TX | |
| Family Medicine Physician | 207Q00000X | 01043972A | IN | Primary |
Addresses
Primary practice location
211 N Eddy St.
South Bend, IN 46617-3096
Mailing address
211 N Eddy St.
South Bend, IN 46617-3096
Phone (574) 246-8816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200152430 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD046481 | DC | MD | Family Medicine Physician |
| 15405 | ND | MD | Family Medicine Physician |
| 52696 | SC | MD | Family Medicine Physician |
| R9778 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1720078108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 N EDDY ST.",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173096",
"telephone_number": "574-246-8816",
"fax_number": "574-204-6345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 N EDDY ST.",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466173096",
"telephone_number": "574-246-8816",
"fax_number": "574-204-6345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HRUSKOVICH",
"first_name": "ROBERT",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-26",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "52696",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301116232",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "DC",
"license": "MD046481",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "15405",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "R9778",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01043972A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200152430",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.