Unknown Individual – Maternal & Fetal Medicine Physician, NPI 1467419861

Unknown Individual is a healthcare provider. based in Fort myers, Florida. specializing in Maternal & Fetal Medicine Physician. They hold a License No. 02615 (KY). The NPI Number for Unknown Individual is 1467419861

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1467419861
Phone
(419) 291-3604
Address
16261 BASS RD STE 100
Deactivation Date
6 October 2023

Doctor Profile

Medical School Name
OHIO UNIVERSITY, COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
2394815477
Graduation Year
1987 (39 years ago)
PAC ID
8921090903
Group Practice PAC ID
4486634417
Professional Enrollment ID
I20181126001606

Contacts

Secure Messaging
mhnat777849@direct.ketteringhealth.org
FHIR Endpoint
https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness85
Years active:0State licenses:3Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 16261 BASS RD STE 100

    FORT MYERS, FL 339083671

    Phone: (419) 291-3604

    Fax: (239) 481-5892

    Type: Mailing

  • 2142 N Cove Blvd

    3rd Floor

    Toledo, OH 436063895

    Phone: (419) 291-3604

    Fax: (419) 479-6971

    Type: Location

  • 3533 Southern Blvd Ste 3750

    Kettering, OH 454291268

    Phone: (937) 610-3220

    Fax: (937) 610-3225

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33908)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4486634417View full group profile
NameSpecialtyState
-FL
-FL
-FL
-FL
O B S T E T R I C S/ G Y N E C O L O G YFL
-FL
O B S T E T R I C S/ G Y N E C O L O G YFL
-SC
O B S T E T R I C S/ G Y N E C O L O G YFL
O B S T E T R I C S/ G Y N E C O L O G YMI

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1467419861 in the public NPI dataset.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Maternal & Fetal Medicine Physician. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Fort Myers, Florida; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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