Unknown Individual – Internal Medicine Physician, NPI 1871504647

Unknown Individual is a healthcare provider. based in Martinsville, Indiana. specializing in Internal Medicine Physician. They hold a License No. 01026194A (IN). The NPI Number for Unknown Individual is 1871504647

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1871504647
Phone
(765) 342-7164
Address
2200 JOHN R. WOODEN DRIVE STE 204
Deactivation Date
11 November 2023

Doctor Profile

Medical School Name
INDIANA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
7653427164
Graduation Year
1975 (51 years ago)
PAC ID
4082700059
Professional Enrollment ID
I20071022000831
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

Provider Addresses for Unknown Individual

  • 2200 JOHN R. WOODEN DRIVE STE 204

    MARTINSVILLE, IN 461511838

    Phone: (765) 342-7164

    Fax: (765) 349-0236

    Type: Location

  • John R Wooden Drive, Martinsville, Morgan County, Indiana, 46151, United States

    SUITE 204

    MARTINSVILLE, IN 461511863

    Phone: (765) 342-7164

    Fax: (765) 349-0236

    Type: Mailing

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 46151)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEIN83036Hemoglobin A1C level7564

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1871504647 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Internal Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Martinsville, Indiana for Unknown Individual based on available NPPES addresses.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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