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

Q: 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.

Q: What is Jacob Lutz's specialty?

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

Q: 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.

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: August 02, 2026.

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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, and ordering and referring status from the CMS PECOS system.

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.

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.

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