Unknown Individual – Family Medicine Physician, NPI 1225187792

Unknown Individual is a healthcare provider. based in Chicago, Illinois. specializing in Family Medicine Physician. They hold a License No. 036044584 (IL). The NPI Number for Unknown Individual is 1225187792

Main info

Organization
Inactive
63 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1225187792
Phone
(773) 772-7230
Address
1802 W CHICAGO AVE
Deactivation Date
5 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7089333840
Graduation Year
1963 (63 years ago)
PAC ID
5395053979
Group Practice PAC ID
5193972164
Professional Enrollment ID
I20150930003375
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

  • 1802-1806, West Chicago Avenue, Ukrainian Village, West Town, Chicago, Cook County, Illinois, 60651, United States

    SUITE 4

    CHICAGO, IL 606225512

    Phone: (773) 772-7230

    Fax: (773) 772-7230

    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)

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 60622)

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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: 5193972164View full group profile
NameSpecialtyState
Nurse PractitionerIL
Family Practice, General PracticeIL
Physician AssistantIL
Nurse PractitionerIL
Nurse PractitionerIL
Internal Medicine, General PracticeIL
Internal MedicineIL
Nurse PractitionerIL

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1225187792 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Chicago?
Public fields place Unknown Individual around Chicago, Illinois. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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