Unknown Individual – Anatomic Pathology Physician, NPI 1467431411

Anatomic Pathology Physician

Unknown Individual is a healthcare provider. based in Belleville, Illinois. specializing in Anatomic Pathology Physician. They hold a License No. 036114715 (IL). The NPI Number for Unknown Individual is 1467431411

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1467431411

Phone

(618) 416-1209

Address

409 LAKE CHRISTINE DR

Deactivation Date

20 December 2023

Doctor Profile

Medical School Name

UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE

Secondary Phone

6182337750

Graduation Year

1979 (47 years ago)

PAC ID

8325062458

Group Practice PAC ID

4789945163

Professional Enrollment ID

I20060117000475

Contacts

FHIR Endpoint

https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness85

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

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Provider Addresses for Unknown Individual

409 LAKE CHRISTINE DR
BELLEVILLE, IL 622212518
Phone: (618) 416-1209
Fax: (618) 416-1209
Type: Mailing
660 S EUCLID AVE
CB 8118
SAINT LOUIS, MO 631101010
Phone: (314) 273-1884
Fax: (314) 747-1710
Type: Mailing
Memorial Hospital, 4500, Memorial Drive, Royal Heights, Belleville, Saint Clair County, Illinois, 62226, United States
DEPT PATHOLOGY
BELLEVILLE, IL 622265360
Phone: (618) 233-7750
Fax: (314) 747-1710
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 62221)

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Provider's Procedures

Unknown Individual performs procedures in Anatomic Pathology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PATHOLOGY	IL	88304	Pathology examination of tissue using a microscope, moderately low complexity	89	81
PATHOLOGY	IL	88342	Tissue or cell analysis by immunologic technique	25	23

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: 4789945163View full group profile

Name	Specialty	State
DR. PATRICIA TEREESE JIMENEZ (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	IL
MRS. MICHELLE MARIE BLOOM (ACNP)	Nurse Practitioner	MO
DR. JOHN L VISCONTI (DO)	Medical Oncology, Internal Medicine, Hematology/Oncology	IL
MRS. MICHELLE VERONICA JACOB (AGNP)	Nurse Practitioner	IL
DR. ALFRED O GRECO (MD)	Medical Oncology, Internal Medicine	IL
DR. GREGORY RICCARDO VLACICH (MD)	Radiation Oncology	IL
MS. STEPHANIE ANNE VOLLMER (ANP)	Nurse Practitioner	MO
DR. CHRISTOPHER DOUGLAS ABRAHAM (MD)	Radiation Oncology	IL
DR. ROXANE MARIE RAMPERSAD (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	IL
DR. MARIA ANNE THOMAS (MD)	Radiation Oncology	IL

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 1467431411.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What healthcare role does Unknown Individual hold?

Scheduling teams often label Unknown Individual under Anatomic Pathology Physician. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Belleville, Illinois; more addresses can appear in NPPES.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.

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