Unknown Individual – Orthopaedic Surgery Physician, NPI 1760475602

Orthopaedic Surgery Physician

Unknown Individual is a healthcare provider. based in Alton, Illinois. specializing in Orthopaedic Surgery Physician. They hold a License No. 036-073440 (IL). The NPI Number for Unknown Individual is 1760475602

Main info

Organization

Inactive

46 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1760475602

Phone

(618) 463-8555

Address

1 PROFESSIONAL DR

Deactivation Date

17 January 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6184638555

Graduation Year

1980 (46 years ago)

PAC ID

0042114928

Group Practice PAC ID

9436389442

Professional Enrollment ID

I20050922000703

Contacts

FHIR Endpoint

https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

1 PROFESSIONAL DR
STE 120
ALTON, IL 62002
Phone: (618) 463-8555
Fax: (618) 463-8556
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)

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: 9436389442View full group profile

Name	Specialty	State
DR. LALITHKUMAR K CHOUHAN (MD)	Internal Medicine, Cardiovascular Disease (Cardiology)	MO
MS. CHLOE SUZANNE DATILLO (NURSE PRACTITIONER)	Nurse Practitioner	MO
RAMA K GONDI (MD)	Cardiovascular Disease (Cardiology), Internal Medicine	MO
ROBERT G LUTAN (MD)	Nuclear Medicine, Cardiovascular Disease (Cardiology), Internal Medicine	MO
SAAD R BITAR (MD)	Cardiovascular Disease (Cardiology), Internal Medicine	MO
SAMER THANAVARO (MD)	-	MO
ELSAYED SALEM ABO-SALEM (MD)	Cardiovascular Disease (Cardiology), Internal Medicine, Interventional Cardiology	TX
THOMAS R KING (MD)	Cardiovascular Disease (Cardiology), Internal Medicine	MO
KARIN C WITT (FNP)	-	IL
SURESH K NARAYANAN (MD)	Cardiovascular Disease (Cardiology), Internal Medicine	MO

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?

The NPI 1760475602 uniquely identifies Unknown Individual in U.S. healthcare data.

What happens when Unknown Individual's NPI is not active?

Public data lists Unknown Individual outside the active bucket for this identifier.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Alton, Illinois in registry-derived data.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.