Unknown Individual – Emergency Medicine Physician, NPI 1407811565

Emergency Medicine Physician

Unknown Individual is a healthcare provider. based in Indianapolis, Indiana. specializing in Emergency Medicine Physician. They hold a License No. 01026677A (IN). The NPI Number for Unknown Individual is 1407811565

Main info

Organization

Inactive

57 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1407811565

Phone

(818) 509-2222

Address

250 N SHADELAND AVE

Deactivation Date

17 October 2022

Doctor Profile

Medical School Name

JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

6613166000

Graduation Year

1969 (57 years ago)

PAC ID

0840197810

Group Practice PAC ID

3072893460

Professional Enrollment ID

I20031217000646

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

North Shadeland Avenue, Castleton, Vertland, Indianapolis, Indiana, 46250, United States
SUITE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS, IN 462194959
Phone: (818) 509-2222
Fax: (317) 962-4343
Type: Mailing
Union Hospital, 1606, North 7th Street, Terre Haute, Vigo County, Indiana, 47804, United States
TERRE HAUTE, IN 478042706
Phone: (812) 238-7523
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 46219)

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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: 3072893460View full group profile

Name	Specialty	State
MARTHA FEENAGHTY (DO)	Emergency Medicine	TX
DR. JOHN D WEILBACKER (DO)	Emergency Medicine	NJ
JOILO BARBOSA (M.D.)	-	WA
EASA GHOREISHI (MD)	Emergency Medicine, Family Practice	IN
REBECCA SAMET (M.D)	-	OR
JENNY AIHONG LIU (MD)	Emergency Medicine, Family Practice, Emergency Medicine	FL
KIHYUN KIM (D.O.)	-	CA
DR. AHSAN SAMAD JANOO (MD)	Emergency Medicine	NY
ANDREW STANITSAS (D.O.)	Emergency Medicine	CA
JAY A GREENSTEIN (MD)	-	CA

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 1407811565.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Emergency Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Indianapolis, Indiana in our summary view.

Is specialty guaranteed by NPI alone?

Taxonomy selections describe intent; scope of practice still follows state law.