Individual provider Active NPI

Elyssa Ann Pittenger, FNP-BC

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1497515720
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71015943A Issued in IN
Practice address
4020 New Vision Dr
Fort Wayne, IN 46845-1737
Phone
(260) 423-2567
Fax
(260) 420-2415
NPI assigned
Mar 21, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 28240879A IN
Nurse Practitioner 363L00000X 71015943A IN Primary

Addresses

Primary practice location

4020 New Vision Dr
Fort Wayne, IN 46845-1737

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Elyssa.Pittenger@forefrontdermatology.emadirect.md

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
I20241204000411 IN Practitioner - Nurse Practitioner 1557897386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forefront Dermatology SC 650 clinicians

Practice addresses (Care Compare)

4020 New Vision Dr
Fort Wayne, IN 46845-1737
Phone (260) 423-2567

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28240879AINMDRegistered Nurse
71015943AINMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Forefront Dermatology SC CurrentSince Aug 11, 2025 Accepting new patients
Forefront Dermatology, S.C. Current Accepting new patients
Forefront Dermatology, S.C. CurrentSince Aug 11, 2025 Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients
Forefront Dermatology, S.C. Past Accepting new patients

Locations

7516 Eagle Crest Blvd
Ste D
Evansville, IN 47715
Phone (812) 401-8999

4020 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 423-2567

303 S Walnut St
Seymour, IN 47274
Phone (812) 358-7705

801 York St
Manitowoc, WI 54220
Phone (866) 630-9882

Interoperability endpoints

  • Direct secure messaging: elyssa.pittenger@forefrontdermatology.emadirect.md

Organizations & group practices 5

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": "1710979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1497515720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451737",
            "telephone_number": "260-423-2567",
            "fax_number": "260-420-2415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITTENGER",
        "first_name": "ELYSSA",
        "middle_name": "ANN",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-21",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28240879A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71015943A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Elyssa.Pittenger@forefrontdermatology.emadirect.md",
            "affiliation": "N",
            "address_1": "4020 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451737",
            "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.