Unknown Individual – Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician, NPI 1174505762

Unknown Individual is a healthcare provider. based in Fort dodge, Iowa. specializing in Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. They hold a License No. 30284 (IA). The NPI Number for Unknown Individual is 1174505762

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174505762
Phone
(515) 574-6840
Address
800 KENYON RD
Deactivation Date
18 December 2025

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Secondary Phone
7129575575
Graduation Year
1982 (44 years ago)
PAC ID
9830373158
Group Practice PAC ID
0446154033
Professional Enrollment ID
I20110412000370
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

  • Kenyon Road, Fort Dodge, Webster County, Iowa, 50501, United States

    FORT DODGE, IA 505015776

    Phone: (515) 574-6840

    Fax: (515) 576-7726

    Type: Location

  • Iowa Heart Center, 5880, University Avenue, West Lakes Office Park, West Des Moines, Polk County, Iowa, 50266, United States

    SUITE 205

    WEST DES MOINES, IA 502668220

    Phone: (515) 633-3835

    Fax: (515) 633-3837

    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 50501)

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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: 0446154033View full group profile
NameSpecialtyState
Nurse PractitionerIA
-IA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1174505762 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Fort Dodge, Iowa as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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