Unknown Individual – Psychiatry Physician, NPI 1477608032

Unknown Individual is a healthcare provider. based in Alton, Illinois. specializing in Psychiatry Physician. They hold a License No. 036-110644 (IL). The NPI Number for Unknown Individual is 1477608032

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477608032
Phone
(618) 462-2331
Address
2615 EDWARDS ST
Deactivation Date
24 February 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6189376483
Graduation Year
2003 (23 years ago)
PAC ID
0446547806
Group Practice PAC ID
2961545173
Professional Enrollment ID
I20160928001958
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2615, Edwards Street, Milton, Alton, Madison County, Illinois, 62002, United States

    ALTON, IL 620023915

    Phone: (618) 462-2331

    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 62002)

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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: 2961545173View full group profile
NameSpecialtyState
Mental Health CounselorIL
-IL
Geriatric Psychiatry, PsychiatryIL
-IL
Clinical Social WorkerIL
Clinical Social WorkerIL
Mental Health CounselorIL
Mental Health CounselorIL
Mental Health CounselorIL
-IL

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1477608032 in the public NPI dataset.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Psychiatry Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Alton, Illinois may find Unknown Individual in results; validate coverage separately.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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Unknown Individual

Psychiatry Physician
2615, Edwards Street, Milton, Alton, Madison County, Illinois, 62002, United States
NPI: 1902995798