Unknown Individual – Physician Assistant, NPI 1124113998

Unknown Individual is a healthcare provider. based in Columbus, Indiana. specializing in Physician Assistant. They hold a License No. 10001076A (IN). The NPI Number for Unknown Individual is 1124113998

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124113998
Phone
(812) 372-8883
Address
2502 25th St
Deactivation Date
29 August 2022

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Secondary Phone
3178819792
Graduation Year
2001 (25 years ago)
PAC ID
5395056261
Group Practice PAC ID
9830371731
Professional Enrollment ID
I20150618001377
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

Provider Addresses for Unknown Individual

  • 2502 25th St

    Columbus, IN 472013728

    Phone: (812) 372-8883

    Fax: (812) 372-8964

    Type: Location

  • 106, West Layton Avenue, Town of Lake, Milwaukee, Milwaukee County, Wisconsin, 53207, United States

    MILWAUKEE, WI 532212600

    Phone: (414) 242-5468

    Fax: (888) 724-0875

    Type: Mailing

  • 745, North Swope Street, Greenfield Courthouse Square Historic District, Greenfield, Hancock County, Indiana, 46140, United States

    GREENFIELD, IN 46140

    Phone: (317) 462-9221

    Fax: (317) 462-3400

    Type: Location

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 47201)

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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: 9830371731View full group profile
NameSpecialtyState
-IN

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1124113998 on file in the registry.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Physician Assistant. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Columbus?
Unknown Individual currently maps to Columbus, Indiana in this extract.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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