Unknown Individual – Interventional Cardiology Physician, NPI 1528055670

Unknown Individual is a healthcare provider. based in Lawrence, Kansas. specializing in Interventional Cardiology Physician. They hold a License No. 0442001 (KS). The NPI Number for Unknown Individual is 1528055670

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1528055670
Phone
(785) 505-3636
Address
1130 W 4TH ST STE 2050
Deactivation Date
23 June 2022

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
7858413636
Graduation Year
1997 (29 years ago)
PAC ID
9032192166
Group Practice PAC ID
1951623834
Professional Enrollment ID
I20190726002554

Contacts

Secure Messaging
elaine.demetroulis@direct.lmh.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 1130 W 4TH ST STE 2050

    LAWRENCE, KS 660441333

    Phone: (785) 505-3636

    Fax: (785) 505-5210

    Type: Mailing

  • 200 Hawkins Dr

    Iowa City, IA 522421009

    Phone: (319) 356-4943

    Fax: (319) 356-4552

    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 66044)

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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: 1951623834View full group profile
NameSpecialtyState
Nurse PractitionerMO
Family PracticeKS
Sports MedicineKS
H O S P I T A L I S TKS
Physician AssistantKS
-KS
Family PracticeKS
Physician AssistantKS
-KS
Internal Medicine, HospitalistMT

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1528055670 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Interventional Cardiology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Lawrence, Kansas.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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