Unknown Individual – Internal Medicine Physician, NPI 1780684100

Unknown Individual is a healthcare provider. based in Davenport, Iowa. specializing in Internal Medicine Physician. They hold a License No. 27082 (IA). The NPI Number for Unknown Individual is 1780684100

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780684100
Phone
(563) 359-5011
Address
3509 SPRING ST
Deactivation Date
22 February 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5737566751
Graduation Year
1986 (40 years ago)
PAC ID
8527969021
Group Practice PAC ID
3072421254
Professional Enrollment ID
I20161109001231

Contacts

FHIR Endpoint
https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience37
Completeness85
Years active:0State licenses:3Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 3509, Spring Street, Spring Village, Davenport, Scott County, Iowa, 52807, United States

    SUITE 3

    DAVENPORT, IA 528072124

    Phone: (563) 359-5011

    Fax: (563) 355-3438

    Type: Mailing

  • 1101 W Liberty St

    Farmington, MO 636401921

    Phone: (573) 756-6751

    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 52807)

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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: 3072421254View full group profile
NameSpecialtyState
-MO
-MO
Family PracticeMO
Hospitalist, Family PracticeMO
Internal MedicineMO
-MO
Family PracticeMO
Internal MedicineIL
Internal Medicine, HospitalistMO
Nurse PractitionerMO

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1780684100.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Internal Medicine Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Davenport, Iowa?
For routing, start with Davenport, Iowa for Unknown Individual, then verify phone and hours locally.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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