Provider Demographics
NPI:1669426763
Name:RAUSCH, JAMES M JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:RAUSCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5602
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46895-5602
Mailing Address - Country:US
Mailing Address - Phone:260-373-4731
Mailing Address - Fax:
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-471-9466
Practice Address - Fax:260-484-5919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN274652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1732OtherPHP
IN000000092617OtherANTHEM
MI4259876100Medicaid
OH0550176Medicaid
IN924750HMedicare ID - Type Unspecified
IN194930MMedicare ID - Type Unspecified
IN000000092617OtherANTHEM
IND94463Medicare UPIN
IN163520OMedicare ID - Type Unspecified
IN190320PMedicare ID - Type Unspecified
IN147380VMedicare ID - Type Unspecified
IN055740IMedicare ID - Type Unspecified
OH0550176Medicaid
IN1732OtherPHP