LISA MICHELLE HOLTSCLAW D.O.
NPI 1619957164
Family Medicine in Fort Wayne, IN

Q: What is Lisa Holtsclaw's NPI number?

The NPI number for Lisa Holtsclaw is 1619957164. It was assigned to this individual provider in the NPPES registry on January 19, 2006.

Q: What is Lisa Holtsclaw's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Holtsclaw was last updated on June 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 January 19, 2006PECOS Enrolled

436 E WASHINGTON BLVD, FORT WAYNE, IN 46802(260) 209-7111(260) 222-2835 Get Directions Write a Review

NPPES record last updated: June 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 22, 2020, Sep 30, 2018, May 19, 2016 (3 updates tracked since 2016).

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About Lisa Michelle Holtsclaw D.o. NPPES

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

LISA MICHELLE HOLTSCLAW D.O. (NPI 1619957164) is an individual family medicine provider in Fort Wayne, Indiana, licensed in Indiana (02001568A) and active in the NPI registry since January 2006. She is enrolled in Medicare PECOS, is affiliated with Parkview Regional Medical Center, and is a graduate of At Still University Of Health Sciences, College Of Osteo Med, Kirksville (1993).

NPPES Registry Identity

NPI1619957164

Entity TypeIndividualFemale

Primary Taxonomy207Q00000X

Provider Legal NameLISA MICHELLE HOLTSCLAWCredential: D.O.

Location Address436 E WASHINGTON BLVDFort Wayne, IN 46802-3210

Mailing Address30 W Monroe St Ste 1200Chicago, IL 60603-2420 · (312) 733-9730 · Fax (773) 866-8014

Phone(260) 209-7111

Fax(260) 222-2835

Sole ProprietorNo

Medical School CMSAt Still University Of Health Sciences, College Of Osteo Med, KirksvilleGraduated 1993

Enumeration DateJanuary 19, 2006

Last NPPES UpdateJune 22, 20203 updates tracked since enumeration

NPPES CertifiedJune 22, 2020

✔ NPI 1619957164 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in IN · 02001568A

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

436 E WASHINGTON BLVD, Fort Wayne, IN 46802

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Other Identifiers 1

Medicaid100373060IN

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lisa Michelle Holtsclaw D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9133133218

PECOS Enrollment IDI20060127000253

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 2

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.

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

43 services29 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

11 services11 patients

Hospital Affiliations CMS Care Compare

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

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46802 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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers13 claims13 services$38.51 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers13 claims13 services$77.00 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 8

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

KEEGAN WILLIAMS

Social Worker (Clinical)