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JACOB THOMAS LUTZ PHD
NPI 1164860052
Clinical Neuropsychologist in Fort Wayne, IN

Active since June 13, 2013PECOS EnrolledAccepts Medicare Assignment
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845(260) 460-3203(260) 460-3271 Get Directions Write a Review

NPPES record last updated: June 13, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Jacob Thomas Lutz Phd NPPES

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

JACOB THOMAS LUTZ PHD (NPI 1164860052) is an individual clinical neuropsychologist in Fort Wayne, Indiana, licensed in Indiana (20042679A) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS and is a graduate of Other (2012).

NPPES Registry Identity

NPI1164860052
Entity TypeIndividualMale
Primary Taxonomy103G00000X
Provider Legal NameJACOB THOMAS LUTZCredential: PHD
Location Address11104 PARKVIEW CIRCLE DR STE 110Fort Wayne, IN 46845-1673
Mailing Address11104 Parkview Circle Dr Ste 110Fort Wayne, IN 46845-1673 · (260) 460-3203 · Fax (260) 460-3271
Phone(260) 460-3203
Fax(260) 460-3271
Sole ProprietorNo
Medical School CMSOtherGraduated 2012
Enumeration DateJune 13, 2013
✔ NPI 1164860052 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in IN · 20042679A
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
11104 PARKVIEW CIRCLE DR STE 110, Fort Wayne, IN 46845
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jacob Thomas Lutz Phd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6901040138
PECOS Enrollment IDI20130910000253
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.

Medicare Billing Reassignment

Medicare enrollment records show Jacob Lutz reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Fort Wayne Neuropsychology LLC
6.2 mi
Clinical Neuropsychologist
4306 E STATE BLVD
Fort Wayne, IN 46815
  • Reassigned Medicare billing, Indiana enrollment
  • 9 clinicians in this Medicare group
NPI 1871032862 (260) 460-3100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of psychological or neuropsychological test by technician, each additional 30 minutes 96139
This service involves a technician administering additional psychological or neuropsychological testing. Each session lasts for an extra 30 minutes. These tests assess cognitive abilities, such as memory, attention, and problem-solving skills, to aid in diagnosing or monitoring mental health conditions.
660 services106 patients
Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
111 services111 patients
Evaluation of neuropsychological test, first hour 96132
An evaluation of neuropsychological tests is a process to assess your brain's function. It involves tasks designed to measure cognitive abilities such as memory, attention, problem-solving, and language skills. The first hour involves initial testing and observation.
107 services106 patients
Administration of psychological or neuropsychological test by technician, first 30 minutes 96138
This procedure involves a trained technician administering a psychological or neuropsychological test. It's a process that assesses your mental function and behavior. The initial session will last 30 minutes. The aim is to understand your cognitive abilities better.
106 services106 patients
Evaluation of neuropsychological test, each additional hour 96133
This service involves further evaluation of your neuropsychological test results beyond the initial hour. It helps to understand your cognitive functioning better, focusing on areas like memory, attention, and problem-solving skills.
89 services89 patients

Other Providers at the Same Location NPPES 20

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

DR. KELLEY RAE LOCKHART M.D.
Internal Medicine (Critical Care Medicine)
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
RICHARD EDWIN CONWAY
Family Medicine
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
DR. JONATHAN TAYLOR GROSSMAN DO
Psychiatry & Neurology (Neurology)
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
NICOLE ALEXANDRA HAGEN
Physician Assistant
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
TYLER ATKINS M.D.
Neurological Surgery
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
DANIEL BUTLER
Physician Assistant
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
KEVIN C BUI MD
Psychiatry & Neurology (Neurology)
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780
KYLE AARON LITTELL M.D.
Physical Medicine & Rehabilitation
11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE, IN 46845
Allen County (260) 425-6780

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 Jacob Lutz's NPI number?

The NPI number for Jacob Lutz is 1164860052. It was assigned to this individual provider in the NPPES registry on June 13, 2013.

Where is Jacob Lutz located?

Jacob Lutz practices at 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845. The listed phone number is (260) 460-3203.

What is Jacob Lutz's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Jacob Lutz enrolled in Medicare?

Yes. Jacob Lutz is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jacob Lutz's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Lutz reassigns Medicare benefits to Fort Wayne Neuropsychology LLC (Fort Wayne, IN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Lutz's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jacob Lutz accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Jacob Lutz as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacob Lutz was last updated on June 13, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.