Unknown Individual – Internal Medicine Physician, NPI 1285674598
Internal Medicine Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
2 GOOD SAMARITAN WAY
SUITE 420
MOUNT VERNON, IL 628642408
Phone: (618) 899-4000
Fax: (618) 899-4790
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)
CMS reports 1 Open Payments records for all available years, with a total value of $24.
Total Amount is formed as General ($24) + Research ($0) + Ownership ($0) = $24.
Last reported payment date: 2024-05-11 • Largest payer in this snapshot: ABBVIE INC. ($24).
Total Amount
$24
General + Research + Ownership
Payments
1
Total payment records
General Amount
$24
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $24 |
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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 143 | 143 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 87 | 87 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 71 | 69 | $0 |
| 83036 | Hemoglobin a1c level | 19 | 19 | $0 |
Insurance plans in this area (ZIP 62864)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| INTERNAL MEDICINE | IL | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 93 | 71 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology), Internal Medicine | IL | |
| Certified Registered Nurse Anesthetist (Crna) | KY | |
| Internal Medicine | IL | |
| Diagnostic Radiology | FL | |
| Certified Registered Nurse Anesthetist (Crna) | IL | |
| Interventional Radiology, Diagnostic Radiology | PA | |
| Cardiac Electrophysiology, Cardiovascular Disease (Cardiology) | MO | |
| A N E S T H E S I O L O G Y | MI | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Hospitalist, Internal Medicine | IL |
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