Unknown Individual – Family Medicine Physician, NPI 1194768960

Unknown Individual is a healthcare provider. based in Knox, Indiana. specializing in Family Medicine Physician. They hold a License No. 01021497A (IN). The NPI Number for Unknown Individual is 1194768960

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194768960
Phone
(574) 772-6030
Address
1002 S EDGEWOOD DR
Deactivation Date
17 April 2025

Doctor Profile

Medical School Name
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2198664135
Graduation Year
1967 (59 years ago)
PAC ID
5496668683
Professional Enrollment ID
I20050316000426
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

  • 1002, Edgewood Drive, Knox, Starke County, Indiana, 46534, United States

    KNOX, IN 465348226

    Phone: (574) 772-6030

    Fax: (574) 772-7494

    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 4 Open Payments records for all available years, with a total value of $64.

Total Amount is formed as General ($64) + Research ($0) + Ownership ($0) = $64.

Last reported payment date: 2023-09-18 • Largest payer in this snapshot: Salix Pharmaceuticals, a division of Bausch Health US, LLC ($30).

Total Amount

$64

General + Research + Ownership

Payments

4

Total payment records

General Amount

$64

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes16968$0
99203New patient office or other outpatient visit, 30-44 minutes6363$0
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Insurance plans in this area (ZIP 46534)

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Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1194768960.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Knox, Indiana. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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