Unknown Individual – Family Medicine Physician, NPI 1851395578

Unknown Individual is a healthcare provider. based in Highland, Illinois. specializing in Family Medicine Physician. They hold a License No. 036073061 (IL). The NPI Number for Unknown Individual is 1851395578

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1851395578
Phone
(618) 651-2727
Address
30 APEX DR
Deactivation Date
4 September 2024

Doctor Profile

Medical School Name
OKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
6183915050
Graduation Year
1981 (45 years ago)
PAC ID
8123053063
Group Practice PAC ID
5193792018
Professional Enrollment ID
I20080818000627
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 30, Apex Drive, Highland, Madison County, Illinois, 62249, United States

    SUITE 2

    HIGHLAND, IL 622491285

    Phone: (618) 651-2727

    Fax: (618) 654-7905

    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 62249)

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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

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1851395578 for Unknown Individual, then check state licensing separately.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Family Medicine Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Highland, Illinois as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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