Unknown Individual – Physician Assistant, NPI 1548329824

Unknown Individual is a healthcare provider. based in Maryville, Illinois. specializing in Physician Assistant. They hold a License No. 08500698 (IL). The NPI Number for Unknown Individual is 1548329824

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548329824
Phone
(618) 391-6405
Address
6810 STATE ROUTE 162 BOX 215
Deactivation Date
1 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6182887244
Graduation Year
1994 (32 years ago)
PAC ID
1658387840
Group Practice PAC ID
5193792018
Professional Enrollment ID
I20060224000477
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

  • 6810 STATE ROUTE 162 BOX 215

    MARYVILLE, IL 620628501

    Phone: (618) 391-6405

    Fax: (618) 288-4088

    Type: Mailing

  • Anderson Hospital Express Care, 108, West US Highway 40, Troy, Madison County, Illinois, 62294, United States

    TROY, IL 62294

    Phone: (618) 391-5065

    Fax: (618) 667-2779

    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 62062)

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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: 5193792018View full group profile
NameSpecialtyState
Nurse PractitionerIL
-IL
General SurgeryIL
-IL
-IL
O B S T E T R I C S/ G Y N E C O L O G YIL
General SurgeryIL
-IL
Family PracticeMO
Family PracticeIL

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1548329824.
Is Unknown Individual excluded from programs when inactive?
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 Physician Assistant. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Maryville, Illinois as a primary anchor for Unknown Individual unless the record lists multiple sites.
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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