Unknown Individual – Surgery Physician, NPI 1780678102

Unknown Individual is a healthcare provider. based in Warsaw, Indiana. specializing in Surgery Physician. They hold a License No. 01039933 (IN). The NPI Number for Unknown Individual is 1780678102

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780678102
Phone
(574) 535-9100
Address
1355 Mariners Dr
Deactivation Date
29 April 2025

Doctor Profile

Medical School Name
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5745468044
Graduation Year
1987 (39 years ago)
PAC ID
4284532623
Group Practice PAC ID
6406835941
Professional Enrollment ID
I20100729000784

Contacts

Secure Messaging
clinical@gsa.directbygreenway.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

  • 1355 Mariners Dr

    Warsaw, IN 465827145

    Phone: (574) 535-9100

    Fax: (574) 535-1020

    Type: Location

  • 1020 High Rd

    Bremen, IN 465061093

    Phone: (574) 535-9100

    Fax: (574) 535-1020

    Type: Location

  • 2006, South Main Street, Historic Racemere Peninsula, Goshen, Elkhart County, Indiana, 46526, United States

    STUITE A

    GOSHEN, IN 465265232

    Phone: (574) 535-9100

    Fax: (574) 535-1020

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $16.

Total Amount is formed as General ($16) + Research ($0) + Ownership ($0) = $16.

Last reported payment date: 2024-12-03 • Largest payer in this snapshot: Intuitive Surgical, Inc. ($16).

Total Amount

$16

General + Research + Ownership

Payments

1

Total payment records

General Amount

$16

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-03

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Intuitive Surgical, Inc.$16
View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes9664$0
99212Established patient office or other outpatient visit, 10-19 minutes6141$0
45380Biopsy of large bowel using a flexible endoscope4544$0
99203New patient office or other outpatient visit, 30-44 minutes4343$0
45385Removal of polyps or growths of large bowel using an endoscope with mechanical snare2929$0
View full utilization report →

Insurance plans in this area (ZIP 46582)

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Provider's Procedures

Unknown Individual performs procedures in Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GENERAL SURGERYIN45378Diagnostic examination of large bowel using an endoscope1919
GENERAL SURGERYIN45385Removal of polyps or growths of large bowel using an endoscope1414

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: 6406835941View full group profile
NameSpecialtyState
-IN
Physician AssistantIN
General SurgeryIN
Nurse PractitionerIN
General SurgeryIN
General SurgeryIN
General SurgeryIN
-IN

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1780678102.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Surgery Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Warsaw, Indiana?
For routing, start with Warsaw, Indiana for Unknown Individual, then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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