Unknown Individual – Sports Medicine (Orthopaedic Surgery) Physician, NPI 1093753337

Sports Medicine (Orthopaedic Surgery) Physician

Unknown Individual is a healthcare provider. based in Hinsdale, Illinois. specializing in Sports Medicine (Orthopaedic Surgery) Physician. They hold a License No. 036041078 (IL). The NPI Number for Unknown Individual is 1093753337

Main info

Organization

Inactive

60 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1093753337

Phone

(630) 323-6116

Address

550 W OGDEN AVE

Deactivation Date

22 September 2021

Doctor Profile

Medical School Name

STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE

Secondary Phone

6303236116

Graduation Year

1966 (60 years ago)

PAC ID

8426150459

Group Practice PAC ID

3476549452

Professional Enrollment ID

I20070222000385

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

550, West Ogden Avenue, Hinsdale, DuPage County, Illinois, 60521, United States
HINSDALE, IL 605213186
Phone: (630) 323-6116
Fax: (630) 323-5309
Type: Mailing
Rollingridge Road, Naperville, Will County, Illinois, 60564, United States
NAPERVILLE, IL 605644216
Phone: (630) 579-6500
Fax: (630) 579-5860
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 60521)

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Provider's Procedures

Unknown Individual performs procedures in Sports Medicine (Orthopaedic Surgery) Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
ORTHOPEDIC SURGERY	IL	20610	Aspiration and/or injection of large joint or joint capsule	66	46

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: 3476549452View full group profile

Name	Specialty	State
DR. MARK A. LORENZ (M.D.)	-	IL
DR. LEAH R URBANOSKY (MD)	-	IL
STEVEN LOUIS	-	IL
KARLA SUE HUDSON (MHS, OTR/L)	-	IL
DR. ROBERT J DALEY (MD)	-	IL

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1093753337 — is the standard way to identify this listing.

Why might Unknown Individual appear inactive while still practicing?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Sports Medicine (Orthopaedic Surgery) Physician in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Hinsdale, Illinois in our summary view.

What does 'Individual Provider' mean on this profile?

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