Unknown Individual – Trauma Surgery Physician, NPI 1417036443

Unknown Individual is a healthcare provider. based in Springfield, Illinois. specializing in Trauma Surgery Physician. They hold a License No. 036134315 (IL). The NPI Number for Unknown Individual is 1417036443

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417036443
Phone
(217) 528-7541
Address
1025 S 6TH ST
Deactivation Date
28 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2175446464
Graduation Year
2003 (23 years ago)
PAC ID
2264434349
Group Practice PAC ID
0547166076
Professional Enrollment ID
I20170405000797

Contacts

Secure Messaging
jaredbernard@sfc.allscriptsdirect.net
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience33
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 1025, South 6th Street, South Town, Springfield, Sangamon County, Illinois, 62703, United States

    SPRINGFIELD, IL 627032403

    Phone: (217) 528-7541

    Type: Mailing

  • HSHS Saint John's Hospital, 800, East Carpenter Street, Springfield, Sangamon County, Illinois, 62769, United States

    SPRINGFIELD, IL 627698366

    Phone: (217) 528-7541

    Type: Location

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 62703)

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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: 0547166076View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1417036443 when you need to reference Unknown Individual in forms, claims, or directories.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Trauma Surgery Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Springfield, Illinois because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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