Unknown Individual – Endocrinology, Diabetes & Metabolism Physician, NPI 1093793937

Unknown Individual is a healthcare provider. based in Wilmette, Illinois. specializing in Endocrinology, Diabetes & Metabolism Physician. They hold a License No. 036-043292 (IL). The NPI Number for Unknown Individual is 1093793937

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093793937
Phone
(847) 906-4910
Address
1135 RIDGE RD
Deactivation Date
20 June 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8508777387
Graduation Year
1969 (57 years ago)
PAC ID
6709981624
Group Practice PAC ID
6103724778
Professional Enrollment ID
I20200604001495
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Ridge Road, Gross Point, Wilmette, New Trier Township, Cook County, Illinois, 60091, United States

    WILMETTE, IL 600911567

    Phone: (847) 906-4910

    Type: Mailing

  • Resurrection Health Care Medical Office Building, 3048-3056, West Peterson Avenue, West Ridge, Chicago, Jefferson Township, Cook County, Illinois, 60659, United States

    CHICAGO, IL 606593720

    Phone: (773) 381-0517

    Fax: (773) 381-0617

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $36.

Total Amount is formed as General ($36) + Research ($0) + Ownership ($0) = $36.

Last reported payment date: 2023-09-07 • Largest payer in this snapshot: ACADIA Pharmaceuticals Inc ($36).

Total Amount

$36

General + Research + Ownership

Payments

2

Total payment records

General Amount

$36

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-07

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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 60091)

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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: 6103724778View full group profile
NameSpecialtyState
R H E U M A T O L O G YKY
Cardiovascular Disease (Cardiology), Internal MedicineFL
Physician AssistantFL
E N D O C R I N O L O G YMN
-FL
Internal MedicineFL
-IA
Physician AssistantFL
Nurse PractitionerFL
Nurse PractitionerOH

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1093793937 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Endocrinology, Diabetes & Metabolism Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Wilmette, Illinois in the same public data insurers reference.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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