Mr Lucas Alan Gravelyn, CRNA in Fort Wayne, IN - Medicare Nurse Anesthetist, Certified Registered

Mr Lucas Alan Gravelyn, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Fort Wayne, Indiana. His current practice location is 6435 W Jefferson Blvd # 434, Fort Wayne, Indiana. You can reach out to his office (for appointments etc.) via phone at (260) 436-7875.

Mr Lucas Alan Gravelyn is licensed to practice in Indiana (license number 28270719A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1528337375.

Contact Information

	Mr Lucas Alan Gravelyn, CRNA
	6435 W Jefferson Blvd # 434, Fort Wayne, IN 46804-6203
	(260) 436-7875
	(260) 432-9812

Map and Direction

Provider's Profile

Full Name	Mr Lucas Alan Gravelyn
Gender	Male
Speciality	Nurse Anesthetist, Certified Registered
Location	6435 W Jefferson Blvd # 434, Fort Wayne, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1528337375
Provider Enumeration Date: 12/23/2011
Last Update Date: 11/03/2025

Medicare PECOS Information:

PECOS PAC ID: 7517124092
Enrollment ID: I20120210000805

Medical Identifiers

Medical identifiers for Mr Lucas Alan Gravelyn such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1528337375	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	28270719A (Indiana)	Primary
367500000X	Nurse Anesthetist, Certified Registered	4704255424 (Michigan)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Lucas Alan Gravelyn allows following entities to bill medicare on his behalf.

Entity Name	Capital Area Anesthesia Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1538105010 PECOS PAC ID: 8628975968 Enrollment ID: O20031216000210

Entity Name	Northstar Anesthesia Of Michigan Ii Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1437268026 PECOS PAC ID: 7911895164 Enrollment ID: O20040309000625

Entity Name	Asa Staffing Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1114378981 PECOS PAC ID: 3971898644 Enrollment ID: O20160818002713

Entity Name	Challenge Anesthesia Staffing Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1275302051 PECOS PAC ID: 8224479332 Enrollment ID: O20240507002588

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Lucas Alan Gravelyn is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Lucas Alan Gravelyn, CRNA Po Box 843603, Dallas, TX 75284-0001 Ph: (972) 233-1999	Mr Lucas Alan Gravelyn, CRNA 6435 W Jefferson Blvd # 434, Fort Wayne, IN 46804-6203 Ph: (260) 436-7875

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Fort Wayne, IN

Anthony Dzigbordi, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 5050 N Clinton St, Fort Wayne, IN 46825 Phone: 260-484-8551
Lisa A Tompa, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 5050 N Clinton St, Fort Wayne, IN 46825 Phone: 260-484-8551 Fax: 260-482-5060
Nicole Borem Schickel, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 5734 Coventry Ln, Fort Wayne, IN 46804 Phone: 260-436-7875
Blair John Walker, RN, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 7950 W Jefferson Blvd, Fort Wayne, IN 46804 Phone: 260-416-3000
Madeline Sikes Brooks, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 10315 Dawsons Creek Blvd Ste Ab, Fort Wayne, IN 46825 Phone: 260-436-7875 Fax: 260-432-9812
Dr. Jennifer Hager, DNP, MBA, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 10315 Dawsons Creek Blvd Ste Ab, Fort Wayne, IN 46825 Phone: 260-436-7875 Fax: 260-432-9812
Lisa Osborne, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 5734 Coventry Ln, Fort Wayne, IN 46804 Phone: 260-436-7875

Mr Lucas Alan Gravelyn, CRNA - Medicare Nurse Anesthetist, Certified Registered in Fort Wayne, IN