Unknown Individual – Family Medicine Physician, NPI 1053387951

Unknown Individual is a healthcare provider. based in Owensboro, Kentucky. specializing in Family Medicine Physician. They hold a License No. 22716 (KY). The NPI Number for Unknown Individual is 1053387951

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053387951
Phone
(270) 926-0234
Address
920 FREDERICA ST
Deactivation Date
19 December 2024

Doctor Profile

Medical School Name
UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE
Secondary Phone
4135842173
Graduation Year
1982 (44 years ago)
PAC ID
3971528217
Group Practice PAC ID
4880963909
Professional Enrollment ID
I20060406000610
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

  • 920, Frederica Street, Owensboro, Daviess County, Kentucky, 42301, United States

    SUITE 104

    OWENSBORO, KY 423013076

    Phone: (270) 926-0234

    Fax: (270) 926-0257

    Mailing address matches the actual address.

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 42301)

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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: 4880963909View full group profile
NameSpecialtyState
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerIN
Physician AssistantIN
-IN
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerIN
Nurse PractitionerTN
Nurse PractitionerIN

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1053387951 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Owensboro, Kentucky. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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