Individual provider Active NPI

Austin Tyler Qualizza, PA-C

  • Surgical Physician Assistant
  • Chesterton, IN
National Provider Identifier
1639778970
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10003133 Issued in IN
Practice address
601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone
(219) 921-1444
Fax
(219) 921-5303
NPI assigned
Oct 19, 2020
Last updated
May 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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 10003133 IN Primary

Addresses

Primary practice location

601 Gateway Blvd N
Chesterton, IN 46304-9658

Mailing address

601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444

Other practice location 1

500 E 109th Ave
Crown Point, IN 46307
Phone (219) 921-1444

Other practice location 2

833 W Lincoln Hwy Ste 110
Schererville, IN 46375-1674
Phone (219) 921-1444

Other identifiers 1

IdentifierTypeStateIssuer
300046175MedicaidIN

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address a.qualizza@lbji.exscribedirect.com Direct
Direct Messaging Address a.qualizza@lbji.exscribedirect.com Direct
Direct Messaging Address a.qualizza@lbji.exscribedirect.com Direct

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
I20201215001646 IN Practitioner - Physician Assistant 8527470657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

500 E 109TH Ave
Crown Point, IN 46307-7294
Phone (219) 921-1444

601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444

833 W Lincoln Hwy
Suite 110
Schererville, IN 46375-1674
Phone (219) 921-1444

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.8 of 100Reported as group
Quality
81.02
Improvement activities
40
Cost
74.12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10003133INMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Bone & Joint Institute, PC CurrentSince Nov 13, 2020 Accepting new patients
Lakeshore Bone & Joint Institute, PC Current Accepting new patients

Locations

601 Gateway Blvd N
Chesterton, IN 46304
Phone (219) 921-1401

500 E 109th Ave
Crown Point, IN 46307

833 W Lincoln Hwy
Ste 110
Schererville, IN 46375

833 W Lincoln Hwy
Ste 110E
Schererville, IN 46375
Phone (219) 427-0700

Interoperability endpoints

  • Direct secure messaging: aqualizza577835@direct.franciscanalliance.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1603065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1639778970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-250-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 E 109th Ave",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "46307",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "833 W Lincoln Hwy Ste 110",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463751674",
            "country_code": "US",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUALIZZA",
        "first_name": "AUSTIN",
        "middle_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-19",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10003133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300046175",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "a.qualizza@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "601 Gateway Blvd N",
            "city": "Chesterton",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463049658",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "a.qualizza@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "833 W Lincoln Hwy Ste 110",
            "city": "Schererville",
            "state": "IN",
            "country_code": "US",
            "postal_code": "463751674",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "a.qualizza@lbji.exscribedirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 E 109th Ave",
            "city": "Crown Point",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chesterton, IN

Sources for this page

Verify at the official NPI Registry.