Unknown Individual – Occupational Therapist, NPI 1639503360

Unknown Individual is a healthcare provider. based in South bend, Indiana. specializing in Occupational Therapist. They hold a License No. 31002258A (IN). The NPI Number for Unknown Individual is 1639503360

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639503360
Phone
(574) 272-9100
Address
3016 Portage Ave
Deactivation Date
8 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3172193889
Graduation Year
1996 (30 years ago)
PAC ID
6204062318
Group Practice PAC ID
0143317693
Professional Enrollment ID
I20131120000639
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 3016 Portage Ave

    South Bend, IN 466283501

    Phone: (574) 272-9100

    Type: Location

  • 419 S JACKSON ST

    BREMEN, IN 465061644

    Phone: (574) 302-6349

    Type: Mailing

  • 6330 N FIR RD

    GRANGER, IN 465304753

    Phone: (574) 247-4071

    Fax: (574) 204-2192

    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 46628)

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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: 0143317693View full group profile

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1639503360.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Occupational Therapist in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with South Bend, Indiana in the same public data insurers reference.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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