Unknown Individual – Radiation Oncology Physician, NPI 1508084765

Radiation Oncology Physician

Unknown Individual is a healthcare provider. based in Des moines, Iowa. specializing in Radiation Oncology Physician. They hold a License No. 37081 (IA). The NPI Number for Unknown Individual is 1508084765

Main info

Organization

Inactive

24 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1508084765

Phone

(515) 643-8780

Address

PO BOX 816

Deactivation Date

17 October 2022

Doctor Profile

Medical School Name

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE

Secondary Phone

Graduation Year

2002 (24 years ago)

PAC ID

3476653965

Group Practice PAC ID

7911810882

Professional Enrollment ID

I20070712000741

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

PO BOX 816
DES MOINES, IA 503040816
Phone: (515) 643-8780
Fax: (515) 643-8962
Type: Mailing
411 LAUREL ST
SUITE C100
DES MOINES, IA 503143017
Phone: (515) 643-8780
Fax: (515) 643-5187
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.

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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 50304)

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Provider's Procedures

Unknown Individual performs procedures in Radiation Oncology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
RADIATION ONCOLOGY	IA	77263	Management of radiation therapy, complex	40	36
RADIATION ONCOLOGY	IA	77300	Calculation of radiation therapy dose	206	28
RADIATION ONCOLOGY	IA	77427	Radiation treatment management, 5 treatments	94	42

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: 7911810882View full group profile

Name	Specialty	State
DAVID B PAUL (PSYD)	Clinical Psychologist	IA
SASHA FARSHID KHOSRAVI (DO)	P S Y C H I A T R Y	IA
JAMES BICE (DO)	-	IA
CARLOS ALARCON-SCHRODER (MD)	Family Practice	IA
DR. SAMUEL HUTCHINSON (DO)	-	NE
TIMOTHY C. DYKSTRA (MD)	Emergency Medicine	IA
AMY FULTON (MD)	Family Practice	IA
KILEY G LOMEN (PA-C)	Physician Assistant	IA
BRIANNA DUERKSEN (PA-C)	-	IA
COLOMBIA ESTHER PTACEK (ARNP)	Nurse Practitioner	IA