JACOB THOMAS LUTZ (NPI# 1164860052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164860052 |
| Entity Type | Individual |
| Full Name | JACOB THOMAS LUTZ |
| Credential | PHD |
| Practice Address |
11104 Parkview Circle Dr Ste 110 Fort Wayne IN 46845-1673 |
| Practice Telephone | 2604603203 |
| Practice Fax Number | 2604603271 |
| Mailing Telephone | 2604603203 |
| Mailing Fax Number | 2604603271 |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2013-06-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 20042679A | IN | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578110441 | Jacob Lutz | Registered Nurse | 800 Prudential Dr, Jacksonville, FL 32207-8202 | 2019-08-24 |
| Street Address |
11104 PARKVIEW CIRCLE DR STE 110 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-1673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780681254 | Frances R. Goff | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1730 | 2005-06-30 |
| 1164938007 | Brandon Emry | Registered Nurse | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2017-12-14 |
| 1750892675 | Curtis Lake | Physician Assistant | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2017-10-18 |
| 1033651260 | Caitlin Camp | Registered Nurse | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845 | 2016-11-04 |
| 1093102022 | Leah Dickstein | Psychiatry & Neurology | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2015-04-16 |
| 1699196519 | Erin Miles | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-12-19 |
| 1467728378 | Usman Kareem Qadeer | Psychiatry & Neurology | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2012-03-25 |
| 1275806663 | Vivian L Appiarius | Nurse Practitioner | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2012-02-15 |
| 1225321664 | Stephanie Reed Falatko | Neurological Surgery | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845 | 2011-05-18 |
| 1659684488 | Shamir Haji | Internal Medicine | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2010-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619275807 | Renee Elizabeth Buskirk | Clinical Neuropsychologist | 11143 Parkview Plaza Dr Ste 207, Fort Wayne, IN 46845-1728 | 2011-03-11 |
| 1780681254 | Frances R. Goff | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1730 | 2005-06-30 |
| 1972508471 | Matthew Paul Ziccardi | Clinical Neuropsychologist | 2200 Randallia Dr, Fort Wayne, IN 46805 | 2005-06-20 |
| 1366911000 | Margarita M Nogin | Clinical Neuropsychologist | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2018-11-23 |
| 1699196519 | Erin Miles | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-12-19 |
| 1689995334 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2010-06-17 |
| 1669701793 | Christina M. Stemmler | Clinical Neuropsychologist | 11104 Parkview Circle Dr, Ste 110, Fort Wayne, IN 46845-1730 | 2009-12-21 |
| 1841524105 | Nivonne Thompson | Clinical Neuropsychologist | 2121 Lake Ave, Fort Wayne, IN 46805-5100 | 2009-09-18 |
| 1205098100 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2008-07-01 |
| 1134241227 | John J Brinkman Jr. | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2007-04-06 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.