Unknown Individual – Obstetrics & Gynecology Physician, NPI 1679685879

Unknown Individual is a healthcare provider. based in Normal, Illinois. specializing in Obstetrics & Gynecology Physician. They hold a License No. 036112101 (IL). The NPI Number for Unknown Individual is 1679685879

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1679685879
Phone
(309) 451-9595
Address
1302 FRANKLIN AVE
Deactivation Date
2 January 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3094519595
Graduation Year
2000 (26 years ago)
PAC ID
8527015296
Group Practice PAC ID
1951358621
Professional Enrollment ID
I20050405000547
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

  • 1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States

    SUITE 3400

    NORMAL, IL 617613551

    Phone: (309) 451-9595

    Fax: (309) 451-9583

    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)

CMS reports 5 Open Payments records for all available years, with a total value of $98.

Total Amount is formed as General ($98) + Research ($0) + Ownership ($0) = $98.

Last reported payment date: 2024-06-11 • Largest payer in this snapshot: Hologic Sales and Service, LLC ($39).

Total Amount

$98

General + Research + Ownership

Payments

5

Total payment records

General Amount

$98

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-11

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination4444$0
Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory3535$0
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Insurance plans in this area (ZIP 61761)

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Provider's Procedures

Unknown Individual performs procedures in Obstetrics & Gynecology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OBSTETRICS/GYNECOLOGYIL82270Stool analysis for blood to screen for colon tumors3535

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1679685879 for Unknown Individual.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Normal, Illinois?
If you are local to Normal, Illinois, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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