Unknown Individual – Family Nurse Practitioner, NPI 1356900773

Unknown Individual is a healthcare provider. based in Syracuse, Indiana. specializing in Family Nurse Practitioner. They hold a License No. F06190842 (IN). The NPI Number for Unknown Individual is 1356900773

Main info

Organization
Inactive
7 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356900773
Phone
(574) 518-0250
Address
11591 N 450 E
Deactivation Date
9 December 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5745842501
Graduation Year
2019 (7 years ago)
PAC ID
9638507767
Group Practice PAC ID
9931008380
Professional Enrollment ID
I20200323003315

Contacts

Other Endpoint
sclark7@goshenhealth.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 11591 N 450 E

    Syracuse, IN 465679564

    Phone: (574) 518-0250

    Type: Location

  • 236, Simpson Avenue, Elkhart, Elkhart County, Indiana, 46516, United States

    ELKHART, IN 465164666

    Phone: (574) 584-7373

    Fax: (574) 293-1739

    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 46567)

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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: 9931008380View full group profile
NameSpecialtyState
-IN
Mental Health CounselorMI
Internal MedicineIN
Nurse PractitionerIN
Nurse PractitionerIN
Family PracticeIN
Nurse PractitionerIN
O B S T E T R I C S/ G Y N E C O L O G YMI
Clinical Social WorkerMI
Nurse PractitionerIN

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1356900773.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Family Nurse Practitioner is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Syracuse, Indiana in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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