Unknown Individual – Emergency Medicine Physician, NPI 1871024406

Unknown Individual is a healthcare provider. based in Coeur d alene, Idaho. specializing in Emergency Medicine Physician. They hold a License No. M-15107 (ID). The NPI Number for Unknown Individual is 1871024406

Main info

Organization
Inactive
9 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1871024406
Phone
(208) 625-4000
Address
2003 KOOTENAI HEALTH WAY
Deactivation Date
6 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2086254000
Graduation Year
2017 (9 years ago)
PAC ID
9335410638
Group Practice PAC ID
3375884372
Professional Enrollment ID
I20200529000791
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2003 KOOTENAI HEALTH WAY

    COEUR D ALENE, ID 838146051

    Phone: (208) 625-4000

    Fax: (208) 625-5731

    Type: Location

  • PO BOX 2318

    COEUR D ALENE, ID 838162318

    Phone: (208) 625-5700

    Type: Mailing

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.

This can happen when there are no reportable CMS Open Payments records.

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.

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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 83814)

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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: 3375884372View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1871024406 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Coeur D Alene, Idaho.
What does 3 location(s) imply?
3 practice locations appear in the available data.

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NPI: 1548253842