Individual provider Active NPI

Todd Lee Deturk, P.A.

  • Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1558332403
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10000810A Issued in IN
Practice address
7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Phone
(260) 436-8686
Fax
(260) 436-8585
NPI assigned
Jan 30, 2006
Last updated
Nov 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10000810A IN Primary

Addresses

Primary practice location

7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133

Mailing address

PO Box 2526
Fort Wayne, IN 46801-2526
Phone (260) 436-8686

Other identifiers 2

IdentifierTypeStateIssuer
OPRMedicaidIN
000000622050OtherANTHEM

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
I20051115000791 IN Practitioner - Physician Assistant 6406875814 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedics-Indianapolis IncGroup PAC ID 7416860663, 357 clinicians
Fort Wayne Orthopaedics, LLCGroup PAC ID 7618965286, 65 clinicians

Practice addresses (Care Compare)

10106 Dupont Circle Dr E
Suite 150
Fort Wayne, IN 46825-1640
Phone (800) 566-5659

4900 Beaner Blvd
Gas City, IN 46933-9788
Phone (800) 566-5659

7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Phone (800) 566-5659

7619 W Jefferson Blvd
Fort Wayne, IN 46804-4133

7631 W Jefferson Blvd
The Imaging Center
Fort Wayne, IN 46804-4133
Phone (260) 436-7770

8450 Northwest Blvd
Indianapolis, IN 46278-1381
Phone (317) 802-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.85 of 100Reported as group
Promoting interoperability
81
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000810AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedics-Indianapolis, Inc CurrentSince Sep 17, 2025 Accepting new patients
Orthopaedics-Indianapolis, Inc CurrentSince Sep 17, 2025 Accepting new patients
Fort Wayne Orthopaedics LLC Physician Assistant CurrentSince Aug 3, 2009 Accepting new patients
Fort Wayne Orthopaedics, LLC CurrentSince Aug 3, 2009 Accepting new patients
Orthopaedics-Indianapolis, Inc Physician Assistant Past Accepting new patients
Redimed Dekalb LLC Past Accepting new patients
Emergency Medicine of Indiana Past Accepting new patients

Locations

10106 DuPont Circle Dr E
Ste 150
Fort Wayne, IN 46825

7601 W Jefferson Blvd
Fort Wayne, IN 46804
Phone 26043686864254

4900 Beaner Blvd
Gas City, IN 46933
Phone (765) 573-0725

8450 Northwest Blvd
Indianapolis, IN 46278

701 Orthopaedic Dr
Ste 120
Warsaw, IN 46582

Interoperability endpoints

  • Direct secure messaging: todd.deturkpa.p1@direct.fwortho.nextgenshare.com

Organizations & group practices 7

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 2

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1558332403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2526",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468012526",
            "telephone_number": "260-436-8686",
            "fax_number": "260-436-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044133",
            "telephone_number": "260-436-8686",
            "fax_number": "260-436-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETURK",
        "first_name": "TODD",
        "middle_name": "LEE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000810A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OPR",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000622050",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.