Active NPI
Elyssa Ann Pittenger, FNP-BC
- Nurse Practitioner
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71015943A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Practice addresses (Care Compare)
4020 New Vision Dr
Fort Wayne, IN 46845-1737
Phone (260) 423-2567
Hospital & facility affiliations
- Parkview Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28240879A | IN | MD | Registered Nurse |
| 71015943A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forefront Dermatology SC | Current | Accepting new patients | |
| Forefront Dermatology, S.C. | Current | Accepting new patients | |
| Forefront Dermatology, S.C. | Current | 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
- 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.
-
- Dermatology Physician
- Fort Wayne, IN
- NPI 1578097572
-
- Dermatology Physician
- Columbus, OH
- NPI 1063365385
-
- Dermatology Physician
- Cedar Rapids, IA
- NPI 1316342611
-
- Dermatology Physician
- Manitowoc, WI
- NPI 1578515904
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.