Unknown Individual – Family Medicine Physician, NPI 1730154543

Unknown Individual is a healthcare provider. based in Holton, Kansas. specializing in Family Medicine Physician. They hold a License No. 0420450 (KS). The NPI Number for Unknown Individual is 1730154543

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1730154543
Phone
(785) 364-2116
Address
1100 COLUMBINE DR
Deactivation Date
24 April 2025

Doctor Profile

Medical School Name
UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Secondary Phone
7853642126
Graduation Year
1983 (43 years ago)
PAC ID
6608830310
Group Practice PAC ID
7810807690
Professional Enrollment ID
I20041112000767
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • Columbine Drive, Holton, Jackson County, Kansas, 66436, United States

    HOLTON, KS 664368824

    Phone: (785) 364-2116

    Fax: (785) 364-9620

    Type: Mailing

  • 1100 COLUMBINE DRIVE

    HOLTON, KS 664368824

    Phone: (785) 364-2116

    Fax: (785) 364-9613

    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.

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 66436)

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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: 7810807690View full group profile
NameSpecialtyState
Family PracticeKS
Nurse PractitionerKS
Nurse PractitionerMO
Nurse PractitionerKS
Nurse PractitionerKS
Family PracticeKS
Nurse PractitionerKS
Nurse PractitionerKS
-KS
Family PracticeKS

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1730154543.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
How should patients interpret Unknown Individual's specialty?
The extract shows Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Holton, Kansas?
If you are local to Holton, Kansas, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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