Unknown Individual – Nurse Practitioner, NPI 1205386711

Unknown Individual is a healthcare provider. based in Schererville, Indiana. specializing in Nurse Practitioner. They hold a License No. 71006618B (IN). The NPI Number for Unknown Individual is 1205386711

Main info

Organization
Inactive
11 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205386711
Phone
(219) 440-7373
Address
1500 INDIANAPOLIS BLVD
Deactivation Date
9 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2197691362
Graduation Year
2015 (11 years ago)
PAC ID
3375824865
Group Practice PAC ID
4284909615
Professional Enrollment ID
I20161221000088
Data current as of
20 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

  • 1500, Indianapolis Boulevard, Stone Bridge, Hartsdale, Schererville, Lake County, Indiana, 46375, United States

    SCHERERVILLE, IN 463751316

    Phone: (219) 440-7373

    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 46375)

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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: 4284909615View full group profile
NameSpecialtyState
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerIN
Internal MedicineIN
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerIN
-IN
Nurse PractitionerIN

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1205386711 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Schererville, Indiana in the same public data insurers reference.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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