Individual provider Active NPI

Kyle A Lutz, PA

  • Surgical Physician Assistant
  • Evansville, IN
National Provider Identifier
1568550804
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10000720A Issued in IN
Practice address
520 Mary St Ste 520
Evansville, IN 47710-1682
Phone
(812) 424-8231
Fax
(812) 435-8794
NPI assigned
Oct 11, 2006
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10000720A IN Primary

Addresses

Primary practice location

520 Mary St Ste 520
Evansville, IN 47710-1682

Mailing address

520 Mary St
Ste 520
Evansville, IN 47710-1682
Phone (812) 424-8231

Other practice location 1

801 Saint Marys Dr Ste 200E
Evansville, IN 47714-0518
Phone (812) 424-8231 ext. 2283

Other practice location 2

4133 Gateway Blvd Ste 290
Newburgh, IN 47630-7918
Phone (812) 424-8231

Other identifiers 4

IdentifierTypeStateIssuer
000000335308OtherANTHEM BCBS
300007791MedicaidIN
9500485900MedicaidKY
100000720OtherININDIANA STATE LICENSE

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
I20040917000806 IN Practitioner - Physician Assistant 0446228456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evansville Surgical Associates IncGroup PAC ID 1557346723, 45 clinicians

Practice addresses (Care Compare)

1125 Professional Blvd
Evansville, IN 47714-8001
Phone (812) 424-8231

3700 Washington Ave
Evansville, IN 47714-0541
Phone (812) 424-8231

4011 Gateway Blvd
Newburgh, IN 47630-8947
Phone (812) 424-8231

520 Mary St
Suite 520
Evansville, IN 47710-1669

520 Mary St
Suite 520
Evansville, IN 47710-1682
Phone (812) 424-8231

600 Mary St
Evansville, IN 47710-1658
Phone (812) 424-8231

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
37.54 of 100Reported as group
Promoting interoperability
0
Improvement activities
40
Cost
65.72

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10000720AINMDSurgical Physician Assistant

Organizations & group practices 1

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 3

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": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1568550804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MARY ST",
            "address_2": "STE 520",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101682",
            "telephone_number": "812-424-8231",
            "fax_number": "812-435-8794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MARY ST STE 520",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101682",
            "telephone_number": "812-424-8231",
            "fax_number": "812-435-8794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Saint Marys Dr Ste 200E",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140518",
            "country_code": "US",
            "telephone_number": "812-424-8231 x2283",
            "fax_number": "812-435-8794",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4133 Gateway Blvd Ste 290",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476307918",
            "country_code": "US",
            "telephone_number": "812-424-8231",
            "fax_number": "812-435-8794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUTZ",
        "first_name": "KYLE",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2026-09-29",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10000720A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000335308",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300007791",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9500485900",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA STATE LICENSE",
            "identifier": "100000720",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.