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JACOB C SHIVELY
NPI 1215672928
Nurse Practitioner in Fort Wayne, IN

Active since April 28, 2022PECOS EnrolledAccepts Medicare Assignment
81.23/100
CMS Quality Rating
11104 PARKVIEW CIRCLE DR STE 330, FORT WAYNE, IN 46845(260) 494-3484(260) 969-0188 Get Directions Write a Review

NPPES record last updated: November 1, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 1, 2023, Oct 12, 2022, Sep 12, 2022 and 2 more (5 updates tracked since 2022).

About Jacob C Shively NPPES

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

JACOB C SHIVELY (NPI 1215672928) is an individual nurse practitioner in Fort Wayne, Indiana, licensed in Indiana (71012742A) and active in the NPI registry since April 2022. He is enrolled in Medicare PECOS, is affiliated with Lutheran Hospital Of Indiana, and maintains a secondary practice location in Fort Wayne.

NPPES Registry Identity

NPI1215672928
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameJACOB C SHIVELY
Location Address11104 PARKVIEW CIRCLE DR STE 330Fort Wayne, IN 46845-1674
Mailing Address120 W 22nd St Ste 200Oak Brook, IL 60523-1563 · (630) 573-5000
Phone(260) 494-3484
Fax(260) 969-0188
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 28, 2022
Last NPPES UpdateNovember 1, 20235 updates tracked since enumeration
NPPES CertifiedNovember 1, 2023
✔ NPI 1215672928 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 · 71012742A
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.
11104 PARKVIEW CIRCLE DR STE 330, Fort Wayne, IN 46845
Open in Google Maps ↗

Secondary Practice Location 1

Location 111104 Parkview Circle Dr Ste 110Fort Wayne, IN 46845-1673 · Phone (260) 425-6780 · Fax (260) 425-6789

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 C Shively 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 ID8628447240
PECOS Enrollment IDI20221202002397
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 3

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.

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
96 services90 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
71 services69 patients
Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes 99221
Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.
68 services62 patients

Hospital Affiliations CMS Care Compare 5

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Lutheran Hospital Of Indiana

Acute Care Hospitals · Fort Wayne, IN
3/5 CMS rating
OwnershipProprietary
CMS Certification Number150017
Location7950 W Jefferson BlvdFort Wayne, IN 46804 · Allen County
Emergency services Birthing friendly

Parkview Regional Medical Center

Acute Care Hospitals · Fort Wayne, IN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150021
Location11109 Parkview Plaza DriveFort Wayne, IN 46845 · Allen County
Emergency services Birthing friendly

Parkview Huntington Hospital

Acute Care Hospitals · Huntington, IN
OwnershipVoluntary non-profit - Private
CMS Certification Number150091
Location2001 Stults RdHuntington, IN 46750 · Huntington County
Emergency services Birthing friendly

Parkview Whitley Hospital

Acute Care Hospitals · Columbia City, IN
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150101
Location1260 E Sr 205Columbia City, IN 46725 · Whitley County
Emergency services Birthing friendly

Parkview Noble Hospital

Acute Care Hospitals · Kendallville, IN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150146
Location401 Sawyer RdKendallville, IN 46755 · Noble County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46845 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.23/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality68.95
Promoting Interoperability100
Improvement Activities40
Cost68.49

Other Providers at the Same Location NPPES 7

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

SHARON WORLTON NP
Registered Nurse
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484
GARIMA GUPTA MD
Internal Medicine (Nephrology)
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 471-5114
MELLISSA HITE FNP-BC
Nurse Practitioner (Family)
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484
NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA, INC
Internal Medicine (Nephrology)
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484
JOHN PAUL RICHARD PA
Physician Assistant
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484
SAM RHOADES PA-C
Physician Assistant
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484
CAITLYN J. LUDWIG PA-C
Physician Assistant
11104 PARKVIEW CIRCLE DR STE 330
FORT WAYNE, IN 46845
Allen County (260) 494-3484

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 Shively's NPI number?

The NPI number for Jacob Shively is 1215672928. It was assigned to this individual provider in the NPPES registry on April 28, 2022.

Where is Jacob Shively located?

Jacob Shively practices at 11104 Parkview Circle Dr Ste 330, Fort Wayne, IN 46845. The listed phone number is (260) 494-3484.

What is Jacob Shively's specialty?

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

Is Jacob Shively enrolled in Medicare?

Yes. Jacob Shively 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.

What insurance does Jacob Shively accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and CareSource list Jacob Shively 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.

Is Jacob Shively affiliated with any hospitals?

According to CMS data, Jacob Shively is affiliated with Lutheran Hospital Of Indiana, Parkview Regional Medical Center, Parkview Huntington Hospital, Parkview Whitley Hospital and Parkview Noble Hospital.

When was this NPI record last updated?

The NPPES record for Jacob Shively was last updated on November 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.