Unknown Individual – Specialist, NPI 1710984794

Unknown Individual is a healthcare provider. based in Burr ridge, Illinois. specializing in INTERVENTIONAL PAIN MANAGEMENT, PAIN MANAGEMENT. They hold a License No. 036082680 (IL). The NPI Number for Unknown Individual is 1710984794

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710984794
Phone
(630) 371-9980
Address
7055 HIGH GROVE BLVD
Deactivation Date
16 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3128096500
Graduation Year
1983 (43 years ago)
PAC ID
4082675780
Group Practice PAC ID
6103918453
Professional Enrollment ID
I20120228000630
Address ID
IL606312127CH6145XHWYX400
Telehealth
Yes
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

309 INTERVENTIONAL PAIN MANAGEMENT in IL

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Provider Addresses for Unknown Individual

  • 7055, High Grove Boulevard, High Grove, Burr Ridge, DuPage County, Illinois, 60527, United States

    SUITE 100

    BURR RIDGE, IL 605277593

    Phone: (630) 371-9980

    Fax: (630) 371-9983

    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 4 Open Payments records for all available years, with a total value of $75.

Total Amount is formed as General ($75) + Research ($0) + Ownership ($0) = $75.

Last reported payment date: 2024-10-31 • Largest payer in this snapshot: Abbott Laboratories ($44).

Total Amount

$75

General + Research + Ownership

Payments

4

Total payment records

General Amount

$75

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-31

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.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20120228000630IInterventional Pain ManagementILTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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
99214Established patient office or other outpatient visit, 30-39 minutes816193$0
Q9966Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml14748$0
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg11446$0
77002Fluoroscopic guidance for needle placement7029$0
20610Aspiration and/or injection of fluid from large joint7029$0
View full utilization report →

Insurance plans in this area (ZIP 60527)

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Provider's Procedures

Unknown Individual performs procedures in INTERVENTIONAL PAIN MANAGEMENT. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERVENTIONAL PAIN MANAGEMENTIL20610Aspiration and/or injection of large joint or joint capsule6735
INTERVENTIONAL PAIN MANAGEMENTIL64493Injections of lower or sacral spine facet joint using imaging guidance6739

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: 6103918453View full group profile
NameSpecialtyState
Nurse PractitionerIL
Interventional Pain Management, AnesthesiologyIL

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1710984794.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Other Service Providers in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Burr Ridge, Illinois in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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Unknown Individual

Infectious Disease Physician
McClintock Drive, Burr Ridge, Lyons Township, Cook County, Illinois, 60480, United States
NPI: 1669492633