Unknown Individual – Pain Medicine (Anesthesiology) Physician, NPI 1548266935

Unknown Individual is a healthcare provider. based in Granite city, Illinois. specializing in Pain Medicine (Anesthesiology) Physician. They hold a License No. 036099203 (IL). The NPI Number for Unknown Individual is 1548266935

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548266935
Phone
(618) 798-3350
Address
2044 MADISON AVE
Deactivation Date
16 June 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6187983350
Graduation Year
1977 (49 years ago)
PAC ID
6901826189
Group Practice PAC ID
6406747906
Professional Enrollment ID
I20070305000148
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2044, Madison Avenue, Granite City, Madison County, Illinois, 62040, United States

    SUITE G-1

    GRANITE CITY, IL 620404641

    Phone: (618) 798-3350

    Fax: (618) 798-3355

    Type: Mailing

  • 2120, Madison Avenue, Granite City, Madison County, Illinois, 62040, United States

    SUITE 106

    GRANITE CITY, IL 620404744

    Phone: (618) 798-3350

    Fax: (618) 798-3355

    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 62040)

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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: 6406747906View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1548266935 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Pain Medicine (Anesthesiology) Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Granite 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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