Unknown Individual – Dermatology Physician, NPI 1396739850

Unknown Individual is a healthcare provider. based in West des moines, Iowa. specializing in Dermatology Physician. They hold a License No. MD-20626 (IA). The NPI Number for Unknown Individual is 1396739850

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396739850
Phone
(515) 875-9925
Address
7147 VISTA DR STE 150
Deactivation Date
26 July 2024

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
5158759100
Graduation Year
1976 (50 years ago)
PAC ID
7315905015
Group Practice PAC ID
4082513742
Professional Enrollment ID
I20041228000726

Contacts

Secure Messaging
williamholtze@tic.allscriptsdirect.net
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

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Provider Addresses for Unknown Individual

  • 7147 VISTA DR STE 150

    WEST DES MOINES, IA 502669313

    Phone: (515) 875-9925

    Fax: (515) 875-9923

    Type: Mailing

  • 1221, Pleasant Street, Sherman Hill, Des Moines, Polk County, Iowa, 50309, United States

    STE 500

    DES MOINES, IA 50309

    Phone: (515) 241-8660

    Fax: (515) 241-8662

    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 50266)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYIA11101Biopsy of each additional growth of skin and/or tissue8869
DERMATOLOGYIA13132Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet3333
DERMATOLOGYIA17003Destruction of 2-14 skin growths2757530

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: 4082513742View full group profile
NameSpecialtyState
Family PracticeIA
Nurse PractitionerIA
P O D I A T R YIA
Internal MedicineIA
Family PracticeIA
-IA
Family PracticeIA
Orthopedic SurgeryMO
Internal MedicineIA
Family PracticeIA

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1396739850 — the number used across U.S. healthcare to identify this provider.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Dermatology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near West Des Moines?
Unknown Individual currently maps to West Des Moines, Iowa in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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