Unknown Individual – Emergency Medicine Physician, NPI 1073539946

Unknown Individual is a healthcare provider. based in Danville, Illinois. specializing in Emergency Medicine Physician. They hold a License No. 036-073783 (IL). The NPI Number for Unknown Individual is 1073539946

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073539946
Phone
(217) 443-5000
Address
812 N LOGAN AVE
Deactivation Date
27 October 2021

Doctor Profile

Medical School Name
RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Secondary Phone
2175326111
Graduation Year
1983 (43 years ago)
PAC ID
7315842952
Group Practice PAC ID
4486547148
Professional Enrollment ID
I20031212000131
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

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Provider Addresses for Unknown Individual

  • Presence United Samaritans Medical Center, 812, North Logan Avenue, Wyton, Danville, Vermilion County, Illinois, 61832, United States

    DANVILLE, IL 618323752

    Phone: (217) 443-5000

    Type: Location

  • 253, Bloomingbank Road, Riverside, Riverside Township, Cook County, Illinois, 60546, United States

    RIVERSIDE, IL 605462724

    Phone: (708) 442-7535

    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.

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 61832)

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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: 4486547148View full group profile
NameSpecialtyState
DR. ROBERT CRUZ VERGARA (MD)
Family PracticeIL
DAVID R PETERSON (M.D.)
Emergency Medicine, Internal MedicineIL
DR. ROBERTO PACHECO-CORONADO (M.D.)
Interventional CardiologyMO
FRANK V AGUIRRE (M.D.)
-IL
DR. SABIR MUHAMMAD RAHMANNY (MD)
Emergency MedicineIN
KATIE WOLLERMAN
Nurse PractitionerMO
BASUNDHARA RAJ
Physician AssistantIL
CRAIG W FURRY (MD)
Family Practice, Emergency MedicineIL
MANSURA GHANI (M.D.)
Cardiovascular Disease (Cardiology)IL
MICHAEL KOEPPEN (MD)
Family Practice, Emergency MedicineIL

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1073539946.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Danville, Illinois. Check all listed addresses for suites or satellite offices.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.