Unknown Individual – Cardiovascular Disease Physician, NPI 1477578300

Unknown Individual is a healthcare provider. based in Idaho falls, Idaho. specializing in Cardiovascular Disease Physician. They hold a License No. M11673 (ID). The NPI Number for Unknown Individual is 1477578300

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477578300
Phone
(208) 523-3050
Address
2001 S WOODRUFF AVE STE 3
Deactivation Date
10 July 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1986 (40 years ago)
PAC ID
6305746983
Professional Enrollment ID
I20070201000616
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • South Woodruff Avenue, Idaho Falls, Bonneville County, Idaho, 83401, United States

    IDAHO FALLS, ID 834046371

    Phone: (208) 523-3050

    Fax: (208) 523-4985

    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 6 Open Payments records for all available years, with a total value of $962.

Total Amount is formed as General ($962) + Research ($0) + Ownership ($0) = $962.

Last reported payment date: 2023-11-27 • Largest payer in this snapshot: Merit Medical Systems Inc ($866).

Total Amount

$962

General + Research + Ownership

Payments

6

Total payment records

General Amount

$962

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-27

Latest reported date

Top Companies

Largest payers in this snapshot

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
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only156103$0
93306Ultrasound of heart with color-depicted blood flow, rate, direction and valve function4544$0
99214Established patient office or other outpatient visit, 30-39 minutes3627$0
99231Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes3020$0
99442Telephone medical discussion with physician, 11-20 minutes2217$0
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Insurance plans in this area (ZIP 83404)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)ID78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies243239
CARDIOVASCULAR DISEASE (CARDIOLOGY)ID92928Catheter insertion of stents in major coronary artery or branch, accessed through the skin2929
CARDIOVASCULAR DISEASE (CARDIOLOGY)ID93280Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report4634

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1477578300.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Idaho Falls, Idaho?
For routing, start with Idaho Falls, Idaho for Unknown Individual, then verify phone and hours locally.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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