Unknown Individual – General Practice Physician, NPI 1487659074

Unknown Individual is a healthcare provider. based in Gibson city, Illinois. specializing in General Practice Physician. They hold a License No. 036047282 (IL). The NPI Number for Unknown Individual is 1487659074

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1487659074
Phone
(217) 379-4864
Address
1120 N MELVIN ST
Deactivation Date
4 December 2020

Doctor Profile

Medical School Name
CHICAGO COLLEGE OF OSTEOPATHY
Secondary Phone
2177844251
Graduation Year
1969 (57 years ago)
PAC ID
5395838197
Group Practice PAC ID
5092703124
Professional Enrollment ID
I20070911000076

Contacts

Secure Messaging
richard.foellner.p5@direct.gapho.nextgenshare.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Gibson Area Hospital & Health Services, 1120, North Melvin Street, Gibson City, Ford County, Illinois, 60936, United States

    GIBSON CITY, IL 609361477

    Phone: (217) 379-4864

    Fax: (217) 379-2604

    Type: Mailing

  • 227, North Market Street, Paxton, Ford County, Illinois, 60957, United States

    PAXTON, IL 609571123

    Phone: (217) 379-4864

    Fax: (217) 379-2604

    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 60936)

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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: 5092703124View full group profile
NameSpecialtyState
SHANE T STACHURA (PT, MPT)
Physical Therapist In Private PracticeIL
Unknown Individual
-IL
GARY W KERBER (MD)
Diagnostic RadiologyIN
MS. NATALIE WEAVER (PMHNP)
-IL
MRS. JODIE VAUGHN (APN)
Nurse PractitionerIL
AMY PAPINEAU (PMHNP-BC)
Nurse PractitionerIL
MRS. MARY ELLEN ALLEN (APN)
-IL
DR. KATHLEEN STEVISON SCHMELKA (MD)
Emergency MedicineMN
DR. MOHAMMED EIKRAM (M.D.)
-IL
MRS. LAURA B BRINKLEY (NP)
-IL

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1487659074 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with General Practice Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Gibson City, Illinois as the reference point for Unknown Individual, then confirm.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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Unknown Individual

General Practice Physician
First National Bank of Ottawa, 409, East Bridge Street, South Streator, Streator, LaSalle County, Illinois, 61364, United States
NPI: 1114925880