NPIMap

Individual provider Active NPI

Tianli Du, MD

  • Trauma Surgery Physician
  • Fort Wayne, IN
National Provider Identifier
1205217148
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
License
01091750A Issued in IN
Practice address
7900 W Jefferson Blvd Ste 306
Fort Wayne, IN 46804-4128
Phone
(260) 458-3610
Fax
(260) 458-3611
NPI assigned
Jun 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X 01091750A IN Primary

Addresses

Primary practice location

7900 W Jefferson Blvd Ste 306
Fort Wayne, IN 46804-4128

Mailing address

6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3514

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tianli.du@lutheranhealthnetwork.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200619002320 OH Practitioner - General Surgery 8820389190 Reassigns benefits to 1 organization
I20240522000841 IN Practitioner - General Surgery 8820389190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Texas Medical Branch at Galveston, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

7900 W Jefferson Blvd
Suite 306
Fort Wayne, IN 46804-4128
Phone (260) 458-3610

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Current Accepting new patients
Lutheran Medical Group LLC CurrentSince May 15, 2024 Accepting new patients
Lutheran Medical Group LLC CurrentSince May 15, 2024 Accepting new patients
Ashtabula County Medical Center CurrentSince Jul 1, 2020 Accepting new patients

Locations

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

7910 W Jefferson Blvd
Ste 112
Fort Wayne, IN 46804
Phone (260) 969-7121

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

7900 W Jefferson Blvd
Ste 306
Fort Wayne, IN 46804
Phone (260) 458-3610

2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919

Interoperability endpoints

  • Direct secure messaging: tdu246087@direct.metrohealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1205217148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3514",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD STE 306",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-458-3610",
            "fax_number": "260-458-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DU",
        "first_name": "TIANLI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-16",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "IN",
            "license": "01091750A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tianli.du@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "7900 W Jefferson Blvd Ste 306",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.