Unknown Individual – Cardiovascular Disease Physician, NPI 1679552517

Cardiovascular Disease Physician

Unknown Individual is a healthcare provider. based in Davenport, Iowa. specializing in Cardiovascular Disease Physician. They hold a License No. 31817 (IA). The NPI Number for Unknown Individual is 1679552517

Main info

Organization

Inactive

46 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1679552517

Phone

(563) 324-2992

Address

1236 E RUSHOLME ST

Deactivation Date

16 October 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3099444625

Graduation Year

1980 (46 years ago)

PAC ID

5395742886

Group Practice PAC ID

2264334721

Professional Enrollment ID

I20061025000603

Contacts

Secure Messaging

vijay.rajendranmd.p1@direct.cvmedpc.nextgenshare.com

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness85

Years active:0State licenses:2Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

1236, East Rusholme Street, Davenport, Scott County, Iowa, 52803, United States
SUITE 300
DAVENPORT, IA 528032473
Phone: (563) 324-2992
Fax: (563) 888-0499
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)

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
93010	Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only	1,435	1,135	$0
99214	Established patient office or other outpatient visit, 30-39 minutes	652	518	$0
99215	Established patient office or other outpatient visit, 40-54 minutes	635	371	$0
93000	Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report	503	460	$0
93306	Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	494	478	$0

View full utilization report →

Insurance plans in this area (ZIP 52803)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
INTERVENTIONAL CARDIOLOGY	IA	78452	Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	33	33
INTERVENTIONAL CARDIOLOGY	IA	93010	Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	88	83
INTERVENTIONAL CARDIOLOGY	IA	93458	Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart	64	62

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: 2264334721View full group profile

Name	Specialty	State
DR. SANJEEV PURI (M.D.)	Interventional Cardiology, Cardiovascular Disease (Cardiology)	IA
MICHELLE LAKE	Nurse Practitioner	IL
DR. BOUYELLA H REDDY (M.D.)	Interventional Cardiology, Cardiovascular Disease (Cardiology), Pediatric Medicine	IA
WENDY G ESCONTRIAS (ARNP)	Nurse Practitioner	IL
NILARUN CHOWDHURI (MD)	Internal Medicine	IL
MEGHAN HITE (ARNP)	Nurse Practitioner	IL
DR. FARAZ MANAZIR (M.D.)	Interventional Cardiology, Cardiovascular Disease (Cardiology)	IA
SHAWNA KAYE DUSKE (ACNP)	Nurse Practitioner	IA
DR. EDMUND P COYNE (M.D.)	Cardiac Electrophysiology, Interventional Cardiology, Cardiovascular Disease (Cardiology)	IA
SHANNON M MENTZER (ARNP)	Nurse Practitioner	IA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1679552517 for Unknown Individual.

What does inactive NPI status mean for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.

What city is tied to Unknown Individual?

The directory associates Unknown Individual with Davenport, Iowa. Check all listed addresses for suites or satellite offices.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.