Unknown Individual – Podiatrist, NPI 1992808216

Podiatrist

Unknown Individual is a healthcare provider. based in Springfield, Illinois. specializing in Podiatrist. They hold a License No. 016002686 (IL). The NPI Number for Unknown Individual is 1992808216

Main info

Organization

Inactive

54 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1992808216

Phone

(217) 787-9192

Address

405 S MACARTHUR BLVD

Deactivation Date

19 October 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2176986228

Graduation Year

1972 (54 years ago)

PAC ID

6305933607

Group Practice PAC ID

9436275369

Professional Enrollment ID

I20071102000530

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

405, South MacArthur Boulevard, Springfield, Sangamon County, Illinois, 62704, United States
SPRINGFIELD, IL 627041742
Phone: (217) 787-9192
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 62704)

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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: 9436275369View full group profile

Name	Specialty	State
DR. THOMAS JOHN JR. COCKAYNE (DPM)	P O D I A T R Y	IL
RICHARD LEE BROWN (D.P.M.)	P O D I A T R Y	IL
DR. JOSEPH P. ROLENS (DPM)	P O D I A T R Y	IL

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?

Yes — Unknown Individual has NPI 1992808216 on file in the registry.

Who updates status for Unknown Individual?

NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.

What expertise is attributed to Unknown Individual?

Unknown Individual's specialty line reads Podiatrist. Clinical services aligned with this taxonomy classification.

Is Unknown Individual located near Springfield?

Unknown Individual currently maps to Springfield, Illinois in this extract.

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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