Unknown Individual – General Practice Physician, NPI 1306884523

General Practice Physician

Unknown Individual is a healthcare provider. based in Floyds knobs, Indiana. specializing in General Practice Physician. They hold a License No. 01029124 (IN). The NPI Number for Unknown Individual is 1306884523

Main info

Organization

Inactive

49 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1306884523

Phone

(812) 923-9177

Address

4613 S SKYLINE DR

Deactivation Date

14 June 2021

Doctor Profile

Medical School Name

UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE

Secondary Phone

5024560494

Graduation Year

1977 (49 years ago)

PAC ID

2961417639

Group Practice PAC ID

6103954847

Professional Enrollment ID

I20101228000032

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience32

Completeness75

Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

4613 S SKYLINE DR
FLOYDS KNOBS, IN 471199005
Phone: (812) 923-9177
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 47119)

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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: 6103954847View full group profile

Name	Specialty	State
VICKY L RAISOR (APRN)	Nurse Practitioner	KY
JONI MILES (APRN)	Nurse Practitioner	TN
MRS. VIRGINIA ANN BONNETTE (ANP)	Nurse Practitioner	AR
MR. OLUWASEGUN A ABE (APRN)	-	KY
MRS. RENEKA SHAVON WIGGINTON (APRN)	-	KY
DR. OSAWARU JUDE OMORUYI (M.D)	Geriatric Medicine, Family Practice, Family Practice, Geriatric Medicine	KY
MARY KATHERINE BIROS	-	KY
MS. LORI E. WEIS (ARNP)	Nurse Practitioner	KY
JENNIFER L. COTE (APN, FNP)	Nurse Practitioner	IL
CONSTANCE M LYONS (APRN)	Nurse Practitioner	KY

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1306884523.

Does inactive mean outdated data for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to General Practice Physician. Clinical services aligned with this taxonomy classification.

Is Unknown Individual tied to Floyds Knobs, Indiana?

If you are local to Floyds Knobs, Indiana, Unknown Individual may be relevant to your search.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.