Alyssa L. Detommaso, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10002198A Issued in IN

Practice address

2516 E Dupont Rd
Fort Wayne, IN 46825-1608

Phone

(260) 458-3050

Fax

(260) 479-4621

NPI assigned

Nov 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2016

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)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Lutheran Medical Group LLC

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1164662805

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Parkview Health System Inc

  dba Parkview Physicians Group

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment NPD
• Lutheran Medical Group LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
  • NPI 1710275664
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1801339791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251608",
            "telephone_number": "260-458-3050",
            "fax_number": "260-479-4621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251608",
            "telephone_number": "260-458-3050",
            "fax_number": "260-479-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETOMMASO",
        "first_name": "ALYSSA",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002198A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alyssa.detommaso@lutheranhealthnetwork.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2516 E DuPont Rd",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468251608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James Desimone, M.D.
• Angela C Despenza, LPN
• Destiny Life Center Cog (Victory House for women)
• Kristi Detar, RBT
• Hannah Kay Detmer
• Dominick Detommaso, D.P.M.
• Jonathan Detommaso, DPM
• Arthur W Detore, M.D.
• Rachael Dettling
• Jonathan Dettmer, PT

• Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.