Unknown Individual – Surgery Physician, NPI 1962456327
Surgery Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Waterloo Post Office, East 4th Street, Waterloo, Monroe County, Illinois, 62298, United States
WATERLOO, IA 507042758
Phone: (319) 833-5907
Fax: (319) 833-5908
Type: Mailing
United Medical Park, 1661-1753, West Ridgeway Avenue, Waterloo, Black Hawk County, Iowa, 50701, United States
STE 107
WATERLOO, IA 507014588
Phone: (319) 833-5907
Fax: (319) 833-5908
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 33 Open Payments records for all available years, with a total value of $662.
Total Amount is formed as General ($662) + Research ($0) + Ownership ($0) = $662.
Last reported payment date: 2024-12-18 • Largest payer in this snapshot: Phathom Pharmaceuticals, Inc. ($204).
Total Amount
$662
General + Research + Ownership
Payments
33
Total payment records
General Amount
$662
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Phathom Pharmaceuticals, Inc. | $204 |
| LeMaitre Vascular, Inc. | $51 |
| TELA Bio, Inc. | $51 |
| Innovation Technologies Inc | $39 |
| Ethicon US, LLC | $34 |
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 |
|---|---|---|---|---|
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 89 | 89 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 70 | 39 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 69 | 64 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 40 | 38 | $0 |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | 40 | 38 | $0 |
Insurance plans in this area (ZIP 50704)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GENERAL SURGERY | IA | 11042 | Removal of skin and tissue first 20 sq cm or less | 11 | 11 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IA | |
| - | IA | |
| O P T O M E T R Y | IA | |
| - | IA | |
| - | IA | |
| Nurse Practitioner | IA | |
| - | IA | |
| - | IA | |
| - | IA | |
| Nurse Practitioner | MN |
Reviews
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