Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Jacob C Shively

Individual provider Nurse Practitioner · NPI 1215672928

Jacob C Shively is a Nurse Practitioner in Fort Wayne, Indiana. Qualified in 2021, 5 years ago. Practices with Nephrology Associates of Northern Indiana PC, a 64-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
5
Licensed in
IN
In the registry since
2022
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Practice location Address checks out

11104 Parkview Circle Dr Ste 330
Fort Wayne, IN 46845-1674
Phone: (260) 494-3484
Fax: (260) 969-0188
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 — (260) 425-6780

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 71012742A (IN)

Record details

NPI number1215672928
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 28, 2022
Last updated in NPPESNovember 1, 2023
Certification dateNovember 1, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Nephrology Associates Of Northern Indiana Pc — 64 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients203
Services billed 247 a service is one billed item, such as a visit, a test or a procedure
Average patient age69

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Payments from drug and device companies, 2025

Drug and device makers are required by federal law (the Physician Payments Sunshine Act) to report what they pay or give to clinicians, and CMS publishes the reports as Open Payments. This is the 2025 program year. A report is a record of a payment, not an allegation of anything, and many are small items such as meals. Only general payments are listed here; research payments and ownership or investment interests are reported separately by CMS and are not shown.

Food and Beverage $13 1 payment · a meal or drink at a meeting or visit, not a fee

Each amount is the sum of what companies reported for that kind of payment in 2025, rounded to the dollar. Not all of it is income to the clinician: a meal is not a fee, a charitable contribution goes to a charity, and a royalty or an acquisition payment is not a salary.

Check a report, or dispute one, at the source in CMS’s own tool, Open Payments. Corrections go through CMS’s dispute process. This site removes a home address on request and asks for no proof, because that is privacy; it will not remove an accurate payment report on request, because that is a statutory public disclosure.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician. Those with a page here are linked.

  • Parkview Huntington Hospital Hospital · Huntington, IN · listed as Huntington Memorial Hospital, Inc
  • Lutheran Hospital Of Indiana Hospital · Fort Wayne, IN
  • Parkview Noble Hospital Hospital · Kendallville, IN
  • Parkview Regional Medical Center Hospital · Fort Wayne, IN
  • Parkview Whitley Hospital Hospital · Columbia City, IN

Colleagues at Nephrology Associates of Northern Indiana PC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 64 clinicians in the practice; 12 are shown here.

Other providers in Fort Wayne