Unknown Individual – Psychiatry Physician, NPI 1053414367

Unknown Individual is a healthcare provider. based in Urbana, Illinois. specializing in Psychiatry Physician. They hold a License No. 036088966 (IL). The NPI Number for Unknown Individual is 1053414367

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053414367
Phone
(217) 383-6792
Address
611 W. PARK ST.
Deactivation Date
28 February 2024

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
2173831850
Graduation Year
1984 (42 years ago)
PAC ID
2365625860
Group Practice PAC ID
3577515774
Professional Enrollment ID
I20110321000913
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

  • Carle Foundation Hospital, 611, West Park Street, Urbana, Champaign County, Illinois, 61801, United States

    BWPC

    URBANA, IL 618012500

    Phone: (217) 383-6792

    Fax: (217) 383-4752

    Type: Mailing

  • Carle Champaign on Kirby, 1813, West Kirby Avenue, Champaign, Champaign County, Illinois, 61821, United States

    PSYCHIATRY/PSYCHOLOGY

    CHAMPAIGN, IL 61821

    Phone: (217) 383-1850

    Fax: (217) 383-3439

    Type: Location

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 61801)

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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: 3577515774View full group profile
NameSpecialtyState
G A S T R O E N T E R O L O G YIL
Nurse PractitionerIL
Clinical PsychologistIL
-FL
Nurse PractitionerIL
Gastroenterology, Internal MedicineWI
P O D I A T R YIL
Hospitalist, Family PracticeTX
Diagnostic RadiologyNY
-IL

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1053414367 — is the standard way to identify this listing.
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 is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Urbana, Illinois; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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