Unknown Individual – Family Medicine Physician, NPI 1558314989

Unknown Individual is a healthcare provider. based in Liberal, Kansas. specializing in Family Medicine Physician. They hold a License No. 04-18124 (KS). The NPI Number for Unknown Individual is 1558314989

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1558314989
Phone
(620) 624-2565
Address
102 E 11TH ST
Deactivation Date
20 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6206242565
Graduation Year
1968 (58 years ago)
PAC ID
8325001621
Group Practice PAC ID
7911137484
Professional Enrollment ID
I20041108000954
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

  • 102, East 11th Street, Liberal, Seward County, Kansas, 67901, United States

    LIBERAL, KS 679012784

    Phone: (620) 624-2565

    Fax: (620) 624-3016

    Type: Mailing

  • 400, Canna Lane, Liberal, Seward County, Kansas, 67901, United States

    LIBERAL, KS 679014915

    Phone: (620) 624-2565

    Fax: (620) 624-3016

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 27 Open Payments records for all available years, with a total value of $489.

Total Amount is formed as General ($489) + Research ($0) + Ownership ($0) = $489.

Last reported payment date: 2024-11-26 • Largest payer in this snapshot: Abbott Laboratories ($213).

Total Amount

$489

General + Research + Ownership

Payments

27

Total payment records

General Amount

$489

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-26

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes268157$0
99214Established patient office or other outpatient visit, 30-39 minutes149105$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit3838$0
81002Urinalysis, manual test3022$0
83036Hemoglobin a1c level1814$0
View full utilization report →

Insurance plans in this area (ZIP 67901)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEKS81002Urinalysis, manual test1916

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: 7911137484View full group profile
NameSpecialtyState
-KS

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1558314989?
NPI 1558314989 belongs to Unknown Individual; compare other details if you need extra assurance.
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 Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Kansas is Unknown Individual registered?
Use Liberal, Kansas as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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