ALYSSA L. DETOMMASO PA-C
NPI 1801339791
Physician Assistant in Fort Wayne, IN

Q: What is Alyssa Detommaso's NPI number?

The NPI number for Alyssa Detommaso is 1801339791. It was assigned to this individual provider in the NPPES registry on November 23, 2016.

Q: What is Alyssa Detommaso's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Alyssa Detommaso was last updated on October 13, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since November 23, 2016PECOS EnrolledAccepts Medicare Assignment

2516 E DUPONT RD, FORT WAYNE, IN 46825(260) 458-3050(260) 479-4621 Get Directions Write a Review

NPPES record last updated: October 13, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 11, 2025, Mar 13, 2020, Nov 23, 2016 (3 updates tracked since 2016).

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About Alyssa L. Detommaso Pa-c NPPES

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

ALYSSA L. DETOMMASO PA-C (NPI 1801339791) is an individual physician assistant in Fort Wayne, Indiana, licensed in Indiana (10002198A) and active in the NPI registry since November 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1801339791

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameALYSSA L. DETOMMASOCredential: PA-C

Location Address2516 E DUPONT RDFort Wayne, IN 46825-1608

Mailing Address2516 E Dupont RdFort Wayne, IN 46825-1608 · (260) 458-3050 · Fax (260) 479-4621

Phone(260) 458-3050

Fax(260) 479-4621

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateNovember 23, 2016

Last NPPES UpdateOctober 13, 20253 updates tracked since enumeration

NPPES CertifiedOctober 13, 2025

✔ NPI 1801339791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in IN · 10002198A

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

2516 E DUPONT RD, Fort Wayne, IN 46825

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.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

Alyssa L. Detommaso Pa-c 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 ID3779868476

PECOS Enrollment IDI20170321000150

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 46825 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

$66.48 typical visit price

range $16.93 – $132.22

Typical copayment $16.62 (range $4.23 – $33.05)

Most-billed visit code 99213

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

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Other Providers at the Same Location NPPES 18

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

MANOLO M. MANALO MD

Family Medicine