Unknown Individual – General Practice Physician, NPI 1003815069

Unknown Individual is a healthcare provider. based in Riverwoods, Illinois. specializing in General Practice Physician. They hold a License No. 036069096 (IL). The NPI Number for Unknown Individual is 1003815069

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003815069
Phone
(847) 325-5110
Address
1105 MILWAUKEE AVE
Deactivation Date
29 January 2026

Doctor Profile

Medical School Name
RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Secondary Phone
8473255110
Graduation Year
1984 (42 years ago)
PAC ID
2062693534
Group Practice PAC ID
4587560594
Professional Enrollment ID
I20110217000168
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

  • 1105 MILWAUKEE AVE

    RIVERWOODS, IL 600153512

    Phone: (847) 325-5110

    Fax: (847) 325-5114

    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)

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.

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
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes871176$0
99424Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month.66085$0
99490Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month9249$0
99315Nursing facility discharge day management, 30 minutes or less2824$0
99305Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes2625$0
View full utilization report →

Insurance plans in this area (ZIP 60015)

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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: 4587560594View full group profile
NameSpecialtyState
Nurse PractitionerIL
-IL
Family PracticeIL
Internal MedicineIL
-IL
Nurse PractitionerIL
Internal Medicine, Family Practice, General PracticeIL
Nurse PractitionerIL

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1003815069.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
General Practice Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Riverwoods, Illinois may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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