Robert Beedle, PHD
Individual provider Active NPI Clinical Psychologist · East Chicago, IN
NPI 1982386751 · NPPES record last updated Nov 4, 2024
Key facts
- NPI
- 1982386751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 20053875B (IN)
- Practice address
- 3903 Indianapolis Blvd
East Chicago, IN 46312-2555 - Phone
- (219) 769-4005
- Fax
- (219) 937-5808
- NPI assigned
- Aug 2, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southlake Community Mental Health Center Inc
Practice addresses (Care Compare)
1441 E 84TH PL
Regional Mental Health Center Merrillville
Merrillville, IN 46410-6578
Phone (219) 736-9115
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241218002256 | IN | Practitioner - Clinical Psychologist | 5698202430 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043875A | IN | MD | Psychologist |
| 20053875B | IN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southlake Community Mental Health Center Inc. | Current |
Accepting new patients | |
| Southlake Community Mental Health Center, Inc. | Past |
Accepting new patients |
Locations
3903 Indianapolis Blvd
East Chicago, IN 46312
Phone (219) 392-6001
2600 Highway Ave
Highland, IN 46322
Phone (219) 757-1953
8555 Taft St
Merrillville, IN 46410
Phone (219) 736-7232
8400 Louisiana St
Merrillville, IN 46410
Phone (219) 757-1924
1441 E 84th Pl
Merrillville, IN 46410
Phone (219) 736-9115
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 20043875A | IN | |
| Community Health Worker | 172V00000X | |||
| Clinical Psychologist | 103TC0700X | 20053875B | IN | Yes |
Addresses
Primary practice location
3903 Indianapolis Blvd
East Chicago, IN 46312-2555
Mailing address
3903 Indianapolis Blvd
East Chicago, IN 46312-2555
Phone (219) 769-4005
Other providers in East Chicago, IN
- Latonya Balkcom
- Todor Teddy Baric
- Raquel B Barreto Castro
- Hunter Bates
- Latoyia Beal
- Hanna-Elyzabeth Faith Bejar
- Cynthia R Bejster
- Alicia Berman
- Ladonna Berryhill
- James Archie Blackwood
All providers in East Chicago, IN · Clinical Psychologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.