Unknown Individual – Internal Medicine Physician, NPI 1104891001

Unknown Individual is a healthcare provider. based in Hinsdale, Illinois. specializing in Internal Medicine Physician. They hold a License No. 036047030 (IL). The NPI Number for Unknown Individual is 1104891001

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104891001
Phone
(630) 323-3600
Address
40 S CLAY ST
Deactivation Date
5 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7083526900
Graduation Year
1970 (56 years ago)
PAC ID
0749180982
Professional Enrollment ID
I20040113000077
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

  • 40, South Clay Street, Hinsdale, DuPage County, Illinois, 60521, United States

    260E

    HINSDALE, IL 605213257

    Phone: (630) 323-3600

    Fax: (630) 323-3927

    Type: Location

  • Lind Avenue, Hillside, Proviso Township, Cook County, Illinois, 60162, United States

    HILLSIDE, IL 601621538

    Phone: (708) 449-3846

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 Open Payments records for all available years, with a total value of $69.

Total Amount is formed as General ($69) + Research ($0) + Ownership ($0) = $69.

Last reported payment date: 2024-01-09 • Largest payer in this snapshot: Teva Pharmaceuticals USA, Inc. ($48).

Total Amount

$69

General + Research + Ownership

Payments

3

Total payment records

General Amount

$69

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-01-09

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
95144Professional service for preparation and provision of single-dose vial of allergen6,39637$0
95004Test for allergy using allergenic extract1,48037$0
99213Established patient office or other outpatient visit, 20-29 minutes932247$0
87635Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen719183$0
95165Professional service for preparation and provision of 1 or more antigens18537$0
View full utilization report →

Insurance plans in this area (ZIP 60521)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1104891001.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Hinsdale, Illinois as a primary anchor for Unknown Individual unless the record lists multiple sites.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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