Unknown Individual – Pain Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1013956523

Unknown Individual is a healthcare provider. based in Springfield, Illinois. specializing in Pain Medicine (Physical Medicine & Rehabilitation) Physician. They hold a License No. 036092746 (IL). The NPI Number for Unknown Individual is 1013956523

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013956523
Phone
(217) 547-9100
Address
1301 S KOKE MILL RD
Deactivation Date
21 February 2024

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF WISCONSIN
Secondary Phone
2175479100
Graduation Year
1990 (36 years ago)
PAC ID
2365426590
Group Practice PAC ID
0143299628
Professional Enrollment ID
I20151027002379
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

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Provider Addresses for Unknown Individual

  • 1301, South Koke Mill Road, Springfield, Sangamon County, Illinois, 62711, United States

    SPRINGFIELD, IL 627119252

    Phone: (217) 547-9100

    Fax: (217) 547-9236

    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
99213Established patient office or other outpatient visit, 20-29 minutes693320$0
64483Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level217164$0
99203New patient office or other outpatient visit, 30-44 minutes161161$0
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg9614$0
95886Needle measurement of electrical activity in arm or leg muscles, complete study8553$0
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Insurance plans in this area (ZIP 62711)

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Provider's Procedures

Unknown Individual performs procedures in Pain Medicine (Physical Medicine & Rehabilitation) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICAL MEDICINE AND REHABILITATIOIL20610Aspiration and/or injection of large joint or joint capsule2823

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: 0143299628View full group profile
NameSpecialtyState
N E U R O S U R G E R YIL
-IL
P O D I A T R YWI
Physician AssistantIL
Orthopedic SurgeryIL
Physical Therapist In Private PracticeIL
Physical Medicine And RehabilitationIL
Nurse PractitionerIL
Orthopedic SurgeryMI
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 1013956523.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Pain Medicine (Physical Medicine & Rehabilitation) Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Springfield, 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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