Unknown Individual – Cardiovascular Disease Physician, NPI 1891797064

Unknown Individual is a healthcare provider. based in Portage, Indiana. specializing in Cardiovascular Disease Physician. They hold a License No. 01028410A (IN). The NPI Number for Unknown Individual is 1891797064

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1891797064
Phone
(219) 762-0400
Address
6375 US HIGHWAY 6 STE B
Deactivation Date
29 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1972 (54 years ago)
PAC ID
3779488028
Group Practice PAC ID
3678737012
Professional Enrollment ID
I20041116000054
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

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Provider Addresses for Unknown Individual

  • B, Shalersville Township, Portage County, Ohio, 44255, United States

    PORTAGE, IN 463685218

    Phone: (219) 762-0400

    Fax: (219) 762-2460

    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)

CMS reports 175 Open Payments records for all available years, with a total value of $5,676.

Total Amount is formed as General ($5,676) + Research ($0) + Ownership ($0) = $5,676.

Last reported payment date: 2024-12-19 • Largest payer in this snapshot: W. L. Gore & Associates, Inc. ($1,687).

Total Amount

$5,676

General + Research + Ownership

Payments

175

Total payment records

General Amount

$5,676

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-19

Latest reported date

Top Companies

Largest payers in this snapshot

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
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only1,4211,093$0
99214Established patient office or other outpatient visit, 30-39 minutes789393$0
93306Ultrasound of heart with color-depicted blood flow, rate, direction and valve function294287$0
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes17888$0
99213Established patient office or other outpatient visit, 20-29 minutes125108$0
View full utilization report →

Insurance plans in this area (ZIP 46368)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)IN85610Blood test, clotting time19762
CARDIOVASCULAR DISEASE (CARDIOLOGY)IN93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report1717

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: 3678737012View full group profile
NameSpecialtyState
Critical Care (Intensivists)IL
-IN
Nurse PractitionerIN
-IN
Cardiovascular Disease (Cardiology), Cardiac ElectrophysiologyIL
Nurse PractitionerIN
-IN
Gynecological Oncology, Obstetrics/GynecologyIN
-IN
Nurse PractitionerIN

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1891797064 on file in the registry.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Portage?
Unknown Individual currently maps to Portage, Indiana in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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