Individual provider Active NPI

Elizabeth Rose Lichtsinn, NP-C

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1235780362
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71009392A Issued in IN
Practice address
7881 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone
(260) 436-8000
Fax
(260) 434-0929
NPI assigned
Sep 20, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71009392A IN Primary

Addresses

Primary practice location

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792

Mailing address

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone (260) 436-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191029003241 IN Practitioner - Nurse Practitioner 1254663917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Wayne Dermatology Consultants IncGroup PAC ID 0042299885, 14 clinicians

Practice addresses (Care Compare)

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792
Phone (260) 436-8000

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021

Merit-based Incentive Payment System (MIPS)

Final score
93.59 of 100Reported as group
Quality
89.18
Promoting interoperability
99
Improvement activities
40
Cost
90.28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71009392AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Wayne Dermatology Consultants Inc CurrentSince Sep 12, 2022 Accepting new patients
Jefferson Pediatrics, PC Family Past Accepting new patients

Locations

7881 Carnegie Blvd
Fort Wayne, IN 46804

11635 Coldwater Rd
Fort Wayne, IN 46845
Phone (260) 637-1661

Interoperability endpoints

  • Direct secure messaging: elichtsinn@fwderm.emadirect.md

Organizations & group practices 2

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

Hospital & facility affiliations 1

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": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1235780362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-434-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-434-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHTSINN",
        "first_name": "ELIZABETH",
        "middle_name": "ROSE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009392A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.