Unknown Individual – Family Medicine Physician, NPI 1023129244
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
1130 W Prairie Ave
Coeur D Alene, ID 838158780
Phone: (208) 818-7055
Fax: (866) 229-7081
Type: Location
1130, West Prairie Avenue, Coeur d'Alene, Kootenai County, Idaho, 83815, United States
COEUR D ALENE, ID 838158780
Phone: (208) 818-7055
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 30 Open Payments records for all available years, with a total value of $602.
Total Amount is formed as General ($602) + Research ($0) + Ownership ($0) = $602.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Ipsen Biopharmaceuticals, Inc ($318).
Total Amount
$602
General + Research + Ownership
Payments
30
Total payment records
General Amount
$602
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Ipsen Biopharmaceuticals, Inc | $318 |
| ABBVIE INC. | $178 |
| PFIZER INC. | $76 |
| Teva Pharmaceuticals USA, Inc. | $17 |
| Axsome Therapeutics, Inc. | $13 |
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J0585 | Injection, onabotulinumtoxina, 1 unit | 10,445 | 16 | $0 |
| J0586 | Injection, abobotulinumtoxina, 5 units | 7,778 | 12 | $0 |
| 95874 | Needle measurement of electrical activity in muscle with injection of chemical for paralysis of nerve muscle | 82 | 24 | $0 |
| 64643 | Injection of chemical for paralysis of nerve muscles on arm or leg, 1-4 muscles, each additional extremity | 78 | 18 | $0 |
| 64616 | Injection of chemical for paralysis of nerve muscles on side of neck excluding voice box | 65 | 20 | $0 |
Insurance plans in this area (ZIP 83815)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| FAMILY MEDICINE | ID | 20610 | Aspiration and/or injection of large joint or joint capsule | 17 | 12 |
Group practice members
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