Individual provider Active NPI

Phornphat Rasamimari, M.D., MPH

  • Neonatal-Perinatal Medicine Physician
  • Munster, IN
National Provider Identifier
1821075383
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
01060038A Issued in IN
Practice address
901 Macarthur Blvd
Neonatology Department
Munster, IN 46321-2901
Phone
(219) 836-2022
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-098723 IL
Neonatal-Perinatal Medicine Physician 2080N0001X 036-098723 IL
Hospitalist Physician 208M00000X 01060038A IN
Neonatal-Perinatal Medicine Physician 2080N0001X 01060038A IN Primary

Addresses

Primary practice location

901 Macarthur Blvd
Neonatology Department
Munster, IN 46321-2901

Mailing address

9201 Calumet Ave
Munster, IN 46321-2807
Phone (219) 836-2022

Other identifiers 3

IdentifierTypeStateIssuer
200510260MedicaidIN
000000964820OtherINANTHEM PROVIDER NUMBER
M471400271OtherINMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address prasamimari@direct.ccprovider.org Direct Cook County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060214000274 IL Practitioner - Pediatric Medicine 9436164308 Reassigns benefits to 3 organizations
I20140819000261 IN Practitioner - Pediatric MedicinePractitioner - Other (Physician) 9436164308 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-098723ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook County CurrentSince Oct 28, 2014 Accepting new patients
Arnett Clinic, LLC CurrentSince Dec 1, 2015 Accepting new patients
Arnett Clinic, LLC Pediatrics CurrentSince Dec 1, 2015 Accepting new patients
Cook County Current Accepting new patients
Franciscan Physician Network CurrentSince Dec 23, 2014 Accepting new patients
Cook County Pediatrics CurrentSince Oct 28, 2014 Accepting new patients
Franciscan Physician Network CurrentSince Dec 23, 2014 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Apr 26, 2010 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Apr 26, 2010 Accepting new patients
Arnett Clinic, LLC Current Accepting new patients
Mount Sinai Community Foundation Current Accepting new patients
Iu Health Medical Group Riley Specialists, LLC Pediatrics CurrentSince Jan 1, 2026 Accepting new patients
Mount Sinai Community Foundation CurrentSince Feb 4, 2017 Accepting new patients
Mount Sinai Community Foundation Pediatrics CurrentSince Feb 4, 2017 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients

Locations

500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000

1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100

8016 Reliable Pkwy
Chicago, IL 60686

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600

1855 W Taylor St
Chicago, IL 60612
Phone (312) 996-6582

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

1201 S Main St
Crown Point, IN 46307
Phone (219) 738-2100

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

2600 Greenbush St
Lafayette, IN 47904

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

Interoperability endpoints

  • Direct secure messaging: prasamimari17403@uihealth.direct-ci.com
  • Direct secure messaging: prasamimari@direct.ccprovider.org

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1821075383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212807",
            "telephone_number": "219-836-2022",
            "fax_number": "219-836-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MACARTHUR BLVD",
            "address_2": "NEONATOLOGY DEPARTMENT",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212901",
            "telephone_number": "219-836-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASAMIMARI",
        "first_name": "PHORNPHAT",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-098723",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036-098723",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01060038A",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01060038A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200510260",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000964820",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "M471400271",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "prasamimari@direct.ccprovider.org",
            "affiliation": "Y",
            "affiliationName": "Cook County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1969 W. Ogden Ave.",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606123723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Munster, IN

Sources for this page

Verify at the official NPI Registry.