Unknown Individual – Clinical Social Worker, NPI 1790776433

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Waterloo, Iowa. specializing in Clinical Social Worker. They hold a License No. 00745 (IA). The NPI Number for Unknown Individual is 1790776433

Main info

Organization

Inactive

39 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1790776433

Phone

(319) 272-2112

Address

2055 KIMBALL AVE

Deactivation Date

23 April 2026

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3192722112

Graduation Year

1987 (39 years ago)

PAC ID

5890721195

Group Practice PAC ID

1850287657

Professional Enrollment ID

I20050708000462

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

2055, Kimball Avenue, Waterloo, Black Hawk County, Iowa, 50702, United States
SUITE 100
WATERLOO, IA 507025014
Phone: (319) 272-2112
Fax: (319) 272-2107
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
90837	Psychotherapy, 1 hour	60	15	$0
90791	Psychiatric diagnostic evaluation	20	19	$0
90834	Psychotherapy, 45 minutes	17	11	$0

View full utilization report →

Insurance plans in this area (ZIP 50702)

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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: 1850287657View full group profile

Name	Specialty	State
DR. ROBERT L FRIEDMAN (M.D.)	-	IA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1790776433 — is the standard way to identify this listing.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Clinical Social Worker in this dataset. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Waterloo, Iowa; more addresses can appear in NPPES.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.