Unknown Individual – Nurse Practitioner, NPI 1184699480

Unknown Individual is a healthcare provider. based in Boise, Idaho. specializing in Nurse Practitioner. They hold a License No. NP-755A (ID). The NPI Number for Unknown Individual is 1184699480

Main info

Organization
Inactive
28 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1184699480
Phone
(208) 381-2711
Address
ST. LUKE'S MOUNTAIN STATES TUMOR INSTITUTE
Deactivation Date
15 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1998 (28 years ago)
PAC ID
3476655093
Group Practice PAC ID
4981878402
Professional Enrollment ID
I20070227000797
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • ST. LUKE'S MOUNTAIN STATES TUMOR INSTITUTE

    100 E. IDAHO STREET

    BOISE, ID 83712

    Phone: (208) 381-2711

    Fax: (208) 381-4675

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $125.

Total Amount is formed as General ($125) + Research ($0) + Ownership ($0) = $125.

Last reported payment date: 2024-04-27 • Largest payer in this snapshot: Astellas Pharma US Inc ($125).

Total Amount

$125

General + Research + Ownership

Payments

1

Total payment records

General Amount

$125

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-04-27

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Astellas Pharma US Inc$125
View all Open Payments →|Open Payments Risk Radar →

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes140105$0
99213Established patient office or other outpatient visit, 20-29 minutes11188$0
View full utilization report →

Insurance plans in this area (ZIP 83712)

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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: 4981878402View full group profile
NameSpecialtyState
Family PracticeME
Internal MedicineID
Family PracticeID
-TX
-OR
Hand SurgeryID
-ID
Nurse PractitionerID
Physician AssistantID
General SurgeryID

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1184699480 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Boise, Idaho for Unknown Individual based on available NPPES addresses.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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