Unknown Individual – Physician Assistant, NPI 1114969813
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1212, Professional Boulevard, Evansville, Vanderburgh County, Indiana, 47714, United States
SUITE B
EVANSVILLE, IN 477148002
Phone: (812) 401-9030
Fax: (812) 401-9033
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 35 Open Payments records for all available years, with a total value of $876.
Total Amount is formed as General ($876) + Research ($0) + Ownership ($0) = $876.
Last reported payment date: 2024-01-17 • Largest payer in this snapshot: PFIZER INC. ($214).
Total Amount
$876
General + Research + Ownership
Payments
35
Total payment records
General Amount
$876
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-01-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $214 |
| Sun Pharmaceutical Industries Inc. | $138 |
| Janssen Biotech, Inc. | $90 |
| ABBVIE INC. | $89 |
| UCB, Inc. | $86 |
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 1,329 | 229 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 797 | 583 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 418 | 327 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 296 | 254 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 251 | 194 | $0 |
Insurance plans in this area (ZIP 47714)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | IN | 17003 | Destruction of 2-14 skin growths | 832 | 144 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| Physician Assistant | IL | |
| P A T H O L O G Y | IN | |
| - | IL | |
| D E R M A T O L O G Y | IL | |
| Physician Assistant | MO | |
| - | IL | |
| D E R M A T O L O G Y | IL | |
| Nurse Practitioner | IL |
Reviews
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