Unknown Individual – Internal Medicine Physician, NPI 1265408694

Unknown Individual is a healthcare provider. based in Forsyth, Illinois. specializing in Internal Medicine Physician. They hold a License No. 230554 (NY). The NPI Number for Unknown Individual is 1265408694

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1265408694
Phone
(217) 791-6703
Address
231 RAPTOR COURT
Deactivation Date
27 November 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2177916703
Graduation Year
1985 (41 years ago)
PAC ID
4981667334
Professional Enrollment ID
I20090212000364
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience33
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 231, Raptor Court, Forsyth, Macon County, Illinois, 62535, United States

    FORSYTH, IL 625359674

    Phone: (217) 791-6703

    Fax: (217) 791-6976

    Type: Mailing

  • The Decatur Professional Plaza, 363, South Main Street, Central Business District, Decatur, Macon County, Illinois, 62523, United States

    SUITE 345

    DECATUR, IL 625231412

    Phone: (217) 791-6703

    Fax: (217) 791-6976

    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 $90.

Total Amount is formed as General ($90) + Research ($0) + Ownership ($0) = $90.

Last reported payment date: 2024-01-18 • Largest payer in this snapshot: Supernus Pharmaceuticals, Inc. ($90).

Total Amount

$90

General + Research + Ownership

Payments

2

Total payment records

General Amount

$90

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-01-18

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
99213Established patient office or other outpatient visit, 20-29 minutes39763$0
99214Established patient office or other outpatient visit, 30-39 minutes340101$0
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes2416$0
90792Psychiatric diagnostic evaluation with medical services2322$0
99233Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes2118$0
View full utilization report →

Insurance plans in this area (ZIP 62535)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INFECTIOUS DISEASEIL90792Psychiatric diagnostic evaluation with medical services2625

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 1265408694.
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 Internal Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Forsyth, Illinois may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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