Unknown Individual – Clinical Social Worker, NPI 1639240211

Unknown Individual is a healthcare provider. based in Mishawaka, Indiana. specializing in Clinical Social Worker. The NPI Number for Unknown Individual is 1639240211

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639240211
Phone
(574) 255-4976
Address
113 LINCOLN WAY EAST
Deactivation Date
16 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5742554976
Graduation Year
1996 (30 years ago)
PAC ID
3779670740
Group Practice PAC ID
5193794006
Professional Enrollment ID
I20071107000729
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 113, Lincoln Way East, Mishawaka, Saint Joseph County, Indiana, 46544, United States

    MISHAWAKA, IN 465442016

    Phone: (574) 255-4976

    Fax: (574) 255-1882

    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 46544)

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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: 5193794006View full group profile

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1639240211; it appears in the national provider directory.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Mishawaka, Indiana for Unknown Individual; download NPPES for the complete set.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1639240211. Always confirm identity and privileges with the practice and licensing boards.

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