Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JESSICA MARIE DZIONDZIAK
NPI 1104620970
Nurse Practitioner in Fort Wayne, IN

Q: What is Jessica Dziondziak's NPI number?

The NPI number for Jessica Dziondziak is 1104620970. It was assigned to this individual provider in the NPPES registry on April 2, 2025.

Q: What is Jessica Dziondziak's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since April 02, 2025PECOS Enrolled

2710 LAKE AVE, FORT WAYNE, IN 46805(260) 481-2700(260) 969-8448 Get Directions Write a Review

NPPES record last updated: June 30, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About Jessica Marie Dziondziak NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA MARIE DZIONDZIAK (NPI 1104620970) is an individual nurse practitioner in Fort Wayne, Indiana, licensed in Indiana (71018138A) and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2026).

NPPES Registry Identity

NPI1104620970

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameJESSICA MARIE DZIONDZIAK

Location Address2710 LAKE AVEFort Wayne, IN 46805-5412

Mailing Address11109 Parkview Plaza Dr # 117Fort Wayne, IN 46845-1701

Phone(260) 481-2700

Fax(260) 969-8448

Sole ProprietorNo

Medical School CMSOtherGraduated 2026

Enumeration DateApril 2, 2025

Last NPPES UpdateJune 30, 2026

NPPES CertifiedJune 30, 2026

✔ NPI 1104620970 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IN · 71018138A

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

2710 LAKE AVE, Fort Wayne, IN 46805

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Marie Dziondziak is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1456825942

PECOS Enrollment IDI20260707000255

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46805 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHEN H. GLASSLEY M.D.

Family Medicine

2710 LAKE AVE
FORT WAYNE, IN 46805

Allen County (260) 373-8070

SHERESA WILSON PA-C, LMHCA

Physician Assistant

2710 LAKE AVE
FORT WAYNE, IN 46805

Allen County (260) 481-2700

MS. SHERRI SUE ALBERTSON PMHNP BC

Nurse Practitioner (Psychiatric/Mental Health)

2710 LAKE AVE
FORT WAYNE, IN 46805

Allen County (260) 471-9440

KAREN S LOTHAMER RN, CNS

Nurse Practitioner

2710 LAKE AVE
FORT WAYNE, IN 46805

Allen County (260) 481-2700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Dziondziak's NPI number?

The NPI number for Jessica Dziondziak is 1104620970. It was assigned to this individual provider in the NPPES registry on April 2, 2025.

Where is Jessica Dziondziak located?

Jessica Dziondziak practices at 2710 Lake Ave, Fort Wayne, IN 46805. The listed phone number is (260) 481-2700.

What is Jessica Dziondziak's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Jessica Dziondziak enrolled in Medicare?

Yes. Jessica Dziondziak is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jessica Dziondziak was last updated on June 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 57 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.