Unknown Individual – Neurological Surgery Physician, NPI 1083704555

Unknown Individual is a healthcare provider. based in Quincy, Illinois. specializing in Neurological Surgery Physician. They hold a License No. 036136713 (IL). The NPI Number for Unknown Individual is 1083704555

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083704555
Phone
(217) 222-6550
Address
1118 HAMPSHIRE ST
Deactivation Date
4 February 2022

Doctor Profile

Medical School Name
UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE
Secondary Phone
2172226550
Graduation Year
1984 (42 years ago)
PAC ID
9537066386
Group Practice PAC ID
0749192375
Professional Enrollment ID
I20150202000898
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

  • 1118, Hampshire Street, Quincy, Adams County, Illinois, 62301, United States

    QUINCY, IL 623013027

    Phone: (217) 222-6550

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $18.

Total Amount is formed as General ($18) + Research ($0) + Ownership ($0) = $18.

Last reported payment date: 2024-06-25 • Largest payer in this snapshot: Boston Scientific Corporation ($18).

Total Amount

$18

General + Research + Ownership

Payments

1

Total payment records

General Amount

$18

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-25

Latest reported date

Top Companies

Largest payers in this snapshot

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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 62301)

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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: 0749192375View full group profile

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1083704555 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Neurological Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Illinois?
You will see Quincy, Illinois on file for Unknown Individual alongside any extra practice locations.
What if Quincy, Illinois seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.