Unknown Individual – Orthopaedic Surgery Physician, NPI 1174559447

Unknown Individual is a healthcare provider. based in Waterloo, Iowa. specializing in Orthopaedic Surgery Physician. They hold a License No. 20001 (IA). The NPI Number for Unknown Individual is 1174559447

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174559447
Phone
(319) 233-6448
Address
4150 KIMBALL AVE
Deactivation Date
4 September 2025

Doctor Profile

Medical School Name
NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Secondary Phone
6417545145
Graduation Year
1968 (58 years ago)
PAC ID
4385554948
Group Practice PAC ID
0941587307
Professional Enrollment ID
I20100301000920
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

  • 4150, Kimball Avenue, Waterloo, Black Hawk County, Iowa, 50701, United States

    PO BOX 2758

    WATERLOO, IA 507019086

    Phone: (319) 233-6448

    Fax: (319) 233-4240

    Type: Mailing

  • 164, West Dale Street, Waterloo, Black Hawk County, Iowa, 50703, United States

    WATERLOO, IA 507031925

    Phone: (319) 233-6448

    Fax: (319) 233-4240

    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 50701)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ORTHOPEDIC SURGERYIA20610Aspiration and/or injection of large joint or joint capsule6842
ORTHOPEDIC SURGERYIA62311Injections of substances into lower or sacral spine5930

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: 0941587307View full group profile
NameSpecialtyState
-FL
Physician AssistantIA
Physician AssistantIA
-MI
Orthopedic SurgeryIA
Certified Registered Nurse Anesthetist (Crna)MO
A N E S T H E S I O L O G YIA
-OH
Certified Registered Nurse Anesthetist (Crna)IA
-FL

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1174559447.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Orthopaedic Surgery Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Waterloo, Iowa in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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