Unknown Individual – Clinical Social Worker, NPI 1104966076

Unknown Individual is a healthcare provider. based in Holland, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801068552 (MI). The NPI Number for Unknown Individual is 1104966076

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104966076
Phone
(616) 392-5141
Address
602 MICHIGAN AVE
Deactivation Date
12 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6163943350
Graduation Year
1991 (35 years ago)
PAC ID
4981649316
Group Practice PAC ID
0446157291
Professional Enrollment ID
I20050624001047
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

Provider Addresses for Unknown Individual

  • 602 MICHIGAN AVE

    HOLLAND, MI 494234918

    Phone: (616) 392-5141

    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 49423)

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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: 0446157291View full group profile

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1104966076 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Holland, Michigan for Unknown Individual; download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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