Unknown Individual – Internal Medicine Physician, NPI 1043260136

Internal Medicine Physician

Unknown Individual is a healthcare provider. based in Chicago, Illinois. specializing in Internal Medicine Physician. They hold a License No. 036093899 (IL). The NPI Number for Unknown Individual is 1043260136

Main info

Organization

Inactive

40 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1043260136

Phone

(773) 257-6770

Address

1501 S CALIFORNIA AVE

Deactivation Date

1 April 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7735728399

Graduation Year

1986 (40 years ago)

PAC ID

0244230902

Group Practice PAC ID

2769702562

Professional Enrollment ID

I20070102000293

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

South California Avenue, Brighton Park, Chicago, Cook County, Illinois, 60629, United States
CHICAGO, IL 606081732
Phone: (773) 257-6770
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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60608)

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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: 2769702562View full group profile

Name	Specialty	State
MR. KURT JEFFREY BROTHERSON (MD)	-	IL
LEOPOLDO JURADO (MD)	-	IL
JOANNA NELSON (FNP-BC)	-	MS
PRECIOUS BIANCA LEVON (FNP-C)	-	IL
ANGELITO FERNANDEZ	-	IL
DR. SHANMUGAVELAYUTHAM RAMASAMY (M.D)	Internal Medicine, Hematology/Oncology, Medical Oncology, Pulmonary Disease	IL
JINI XAVIER MADATHIL (NP)	-	IL
DR. HEMANT VITHAL GINDE (M.D.)	-	IL
LINDA ANN PARISH (R.N. N.P.)	-	IL

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?

Yes. Unknown Individual is listed with NPI 1043260136 in the public NPI dataset.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Internal Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

Does Unknown Individual list a practice location?

Patients near Chicago, Illinois may find Unknown Individual in results; validate coverage separately.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.