Unknown Individual – Emergency Medicine Physician, NPI 1184661779

Emergency Medicine Physician

Unknown Individual is a healthcare provider. based in Virginia, Illinois. specializing in Emergency Medicine Physician. They hold a License No. 036-097359 (IL). The NPI Number for Unknown Individual is 1184661779

Main info

Organization

Inactive

31 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1184661779

Phone

(217) 452-3220

Address

20942 IL ROUTE 125

Deactivation Date

3 July 2024

Doctor Profile

Medical School Name

UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO

Secondary Phone

6186352200

Graduation Year

1995 (31 years ago)

PAC ID

4981627288

Group Practice PAC ID

2365341567

Professional Enrollment ID

I20060112000821

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

Provider Addresses for Unknown Individual

20942 IL ROUTE 125
VIRGINIA, IL 626911306
Phone: (217) 452-3220
Fax: (217) 452-7447
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99284	Emergency department visit with moderate level of medical decision making	50	50	$0
99285	Emergency department visit with high level of medical decision making	25	24	$0
99283	Emergency department visit with low level of medical decision making	21	21	$0

View full utilization report →

Insurance plans in this area (ZIP 62691)

Loading plans...

Provider's Procedures

Unknown Individual performs procedures in Emergency Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	IL	93010	Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	51	47

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: 2365341567View full group profile