Unknown Individual – Emergency Medicine Physician, NPI 1497740898

Emergency Medicine Physician

Unknown Individual is a healthcare provider. based in Fort wayne, Indiana. specializing in Emergency Medicine Physician. They hold a License No. 02001358A (IN). The NPI Number for Unknown Individual is 1497740898

Main info

Organization

Inactive

35 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1497740898

Phone

(260) 602-4892

Address

12207 CREE CT

Deactivation Date

16 October 2025

Doctor Profile

Medical School Name

AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE

Secondary Phone

5747537541

Graduation Year

1991 (35 years ago)

PAC ID

9638231806

Group Practice PAC ID

8022311729

Professional Enrollment ID

I20081222000566

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

Loading map...

Provider Addresses for Unknown Individual

12207, Cree Court, Chestnut Hills, Fort Wayne, Allen County, Indiana, 46814, United States
FORT WAYNE, IN 468149162
Phone: (260) 602-4892
Fax: (260) 625-5732
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 46814)

Loading plans...

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: 8022311729View full group profile

Name	Specialty	State
DR. JAMES RAYMOND RUDOLPH (M.D.)	-	IN
JANICE ELAINE MORECRAFT (NP)	-	ME
LORRAINE DOUGHERTY (FNP)	-	IN

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?

Yes. Unknown Individual is listed with NPI 1497740898 in the public NPI dataset.

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 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.

Does Unknown Individual list a practice location?

Patients near Fort Wayne, Indiana may find Unknown Individual in results; validate coverage separately.

How many locations tie to this NPI?

2 practice locations appear in the available data.