Unknown Individual – Clinical Social Worker, NPI 1548640162

Unknown Individual is a healthcare provider. based in Alton, Illinois. specializing in Clinical Social Worker. They hold a License No. 149.017496 (IL). The NPI Number for Unknown Individual is 1548640162

Main info

Organization
Inactive
15 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548640162
Phone
(618) 462-2331
Address
2615 Edwards St
Deactivation Date
14 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6189394444
Graduation Year
2011 (15 years ago)
PAC ID
3072874163
Group Practice PAC ID
8729166434
Professional Enrollment ID
I20180307000091
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 2615 Edwards St

    Alton, IL 620023915

    Phone: (618) 462-2331

    Fax: (618) 462-7160

    Type: Location

  • 1218 19TH ST

    GRANITE CITY, IL 620404501

    Phone: (618) 709-7647

    Fax: (618) 452-2832

    Type: Mailing

  • 1218 19th St

    Granite City, IL 620404501

    Phone: (618) 709-7647

    Fax: (618) 452-2832

    Type: Location

  • 448 WYLIE DR

    NORMAL, IL 617615405

    Phone: (618) 512-1803

    Type: Mailing

  • 12 N 64TH ST

    BELLEVILLE, IL 622233809

    Phone: (618) 877-4420

    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 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: 8729166434View full group profile
NameSpecialtyState
Clinical Social WorkerIL
-IL
-AK
Mental Health CounselorIL

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1548640162 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Alton, Illinois as the reference point for Unknown Individual, then confirm.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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