Individual provider Active NPI

Sushil K. Jain, MD

  • Gastroenterology Physician
  • Fort Wayne, IN
National Provider Identifier
1649247057
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01051909A Issued in IN
Practice address
7900 W Jefferson Blvd
Suite 201
Fort Wayne, IN 46804-4128
Phone
(260) 432-2297
Fax
(260) 969-7266
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01051909A IN Primary

Addresses

Primary practice location

7900 W Jefferson Blvd
Suite 201
Fort Wayne, IN 46804-4128

Mailing address

6920 Pointe Inverness Way Ste 200
Fort Wayne, IN 46804-7934
Phone (260) 479-3514

Other identifiers 3

IdentifierTypeStateIssuer
2187860MedicaidOH
000000110957OtherINANTHEM
200271250MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sushil.jain@lutheranhealthnetwork.cernerdirect.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050219000033 IN Practitioner - Gastroenterology 7416909221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Practice addresses (Care Compare)

2510 E Dupont Rd
Fort Wayne, IN 46825-1603

2516 E Dupont Rd
Fort Wayne, IN 46825-1608
Phone (260) 434-6076

2520 E Dupont Rd
Dupont Hospital
Fort Wayne, IN 46825-1675
Phone (260) 432-2297

7900 W Jefferson Blvd
Fort Wayne, IN 46804-4128

7916 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 432-2297

7938 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 436-8583

7950 W Jefferson Blvd
Lutheran Hospital
Fort Wayne, IN 46804-4140
Phone (260) 435-7001

7952 W Jefferson Blvd
The Orthopedic Hospital
Fort Wayne, IN 46804-4140
Phone (260) 435-2999

7956 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 435-2836

7970 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 435-6105

7988 W Jefferson Blvd
Fort Wayne, IN 46804-4140
Phone (260) 969-7280

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.99 of 100Reported as apm
Quality
77.41
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy152
Upper gastrointestinal (GI) endoscopy for acid reflux187

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Medical Group LLC CurrentSince May 1, 2009 Accepting new patients
Lutheran Medical Group LLC CurrentSince May 1, 2009 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

2510 E DuPont Rd
Ste 206
Fort Wayne, IN 46825
Phone (260) 416-5954

3534 Brooklyn Ave
Fort Wayne, IN 46809
Phone (219) 478-5180

7900 W Jefferson Blvd
Ste 201
Fort Wayne, IN 46804
Phone (260) 969-7100

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

7916 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-2298

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

Organizations & group practices 3

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 4

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1649247057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3514",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 W JEFFERSON BLVD",
            "address_2": "SUITE 201",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044128",
            "telephone_number": "260-432-2297",
            "fax_number": "260-969-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "SUSHIL",
        "middle_name": "K.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01051909A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2187860",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000110957",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200271250",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sushil.jain@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "7900 W Jefferson Blvd",
            "address_2": "Suite 201",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044128",
            "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.