Unknown Individual – Clinical Social Worker, NPI 1205923935

Unknown Individual is a healthcare provider. based in Overland park, Kansas. specializing in Clinical Social Worker. They hold a License No. 005476 (MO). The NPI Number for Unknown Individual is 1205923935

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205923935
Phone
(913) 541-1700
Address
7180 W 107TH ST STE 4
Deactivation Date
31 January 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5102010190
Graduation Year
1994 (32 years ago)
PAC ID
0244382661
Group Practice PAC ID
1052697455
Professional Enrollment ID
I20090716000250
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 7180 W 107TH ST STE 4

    OVERLAND PARK, KS 662122523

    Phone: (913) 541-1700

    Fax: (913) 492-1480

    Type: Location

  • 10312, Garnett Street, Montrachet, Overland Park, Johnson County, Kansas, 66214, United States

    OVERLAND PARK, KS 662142647

    Phone: (913) 492-3828

    Fax: (913) 492-1480

    Type: Mailing

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 66212)

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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: 1052697455View full group profile

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1205923935?
NPI 1205923935 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Overland Park?
Public fields place Unknown Individual around Overland Park, Kansas. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.