Individual provider Active NPI

Gregory A Louck, CRNA

  • Certified Registered Nurse Anesthetist
  • Fort Wayne, IN
National Provider Identifier
1730413220
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704258243 Issued in MI
Practice address
5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone
(260) 484-8551
NPI assigned
Sep 30, 2009
Last updated
Dec 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704258243 MI Primary

Addresses

Primary practice location

5050 N Clinton St
Fort Wayne, IN 46825-5886

Mailing address

5052 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 408-2203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111111000247 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416095062 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgery One Anesthesia LLCGroup PAC ID 8820351463, 32 clinicians

Practice addresses (Care Compare)

5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone (260) 484-8551

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Indiana Anesthesia Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2023 Accepting new patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2022 Accepting new patients
Anesthesia Care Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 25, 2022 Accepting new patients
Surgery One Anesthesia, LLC CurrentSince Jan 3, 2023 Accepting new patients
Ams Northern Indiana LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 10, 2024 Accepting new patients
Northern Indiana Anesthesia Services, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Past Accepting new patients

Locations

4411 Washington Ave
Ste 100
Evansville, IN 47714
Phone (313) 637-9861

801 Saint Marys Dr
Ste 205
Evansville, IN 47714
Phone (812) 477-6103

801 Saint Marys Dr
Ste 205W
Evansville, IN 47714
Phone (812) 477-6103

5050 N Clinton St
Fort Wayne, IN 46825
Phone (219) 484-8551

5052 N Clinton St
Fort Wayne, IN 46825
Phone (260) 408-2203

647 2nd St
Ste A
Jasper, IN 47546
Phone (812) 477-6103

3800 Venetian Way
Ste 100
Newburgh, IN 47630
Phone (812) 266-2903

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

1400 E 9th St
Rochester, IN 46975
Phone (574) 223-2020

53830 Generations Dr
South Bend, IN 46635
Phone (574) 217-0174

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 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": "1254268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1730413220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5052 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255822",
            "telephone_number": "260-408-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 N CLINTON ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255886",
            "telephone_number": "260-484-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOUCK",
        "first_name": "GREGORY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-30",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704258243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.