Unknown Individual – Family Medicine Physician, NPI 1861574451

Unknown Individual is a healthcare provider. based in Liberty, Kentucky. specializing in FAMILY PRACTICE. They hold a License No. 02794 (KY). The NPI Number for Unknown Individual is 1861574451

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1861574451
Phone
(606) 787-6275
Address
187 WOLFORD AVE
Deactivation Date
9 April 2026

Doctor Profile

Medical School Name
AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Secondary Phone
60678762751167
Graduation Year
1981 (45 years ago)
PAC ID
1557377165
Group Practice PAC ID
0749193423
Professional Enrollment ID
I20060306000402
Address ID
KY425393278LI187XXAVEX300
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

1,717 FAMILY PRACTICE in KY

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Provider Addresses for Unknown Individual

  • Casey County Hospital, 187, Wolford Avenue, Liberty, Casey County, Kentucky, 42539, United States

    LIBERTY, KY 425393278

    Phone: (606) 787-6275

    Fax: (606) 787-0251

    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)

CMS reports 69 Open Payments records for all available years, with a total value of $1,119.

Total Amount is formed as General ($1,119) + Research ($0) + Ownership ($0) = $1,119.

Last reported payment date: 2024-12-11 • Largest payer in this snapshot: Bayer Healthcare Pharmaceuticals Inc. ($342).

Total Amount

$1,119

General + Research + Ownership

Payments

69

Total payment records

General Amount

$1,119

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-11

Latest reported date

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.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20060306000402IFamily PracticeKYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes25380$0
View full utilization report →

Insurance plans in this area (ZIP 42539)

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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: 0749193423View full group profile
NameSpecialtyState
Hospitalist, Internal MedicineNJ
-KY
Nurse PractitionerKY
Diagnostic RadiologyKY
Emergency Medicine, Internal MedicineKY
Internal MedicineKY
Nurse PractitionerKY
Nurse PractitionerKY
Emergency Medicine, Family PracticeKY

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1861574451.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Liberty, Kentucky in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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