Unknown Individual – Urology Physician, NPI 1124087143

Unknown Individual is a healthcare provider. based in Adrian, Michigan. specializing in Urology Physician. They hold a License No. 4301050907 (MI). The NPI Number for Unknown Individual is 1124087143

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124087143
Phone
(517) 265-4770
Address
777 KIMOLE LN
Deactivation Date
17 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5172636464
Graduation Year
1973 (53 years ago)
PAC ID
9537231725
Group Practice PAC ID
7012902265
Professional Enrollment ID
I20080703000139
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

  • 777, Kimole Lane, Adrian, Lenawee County, Michigan, 49221, United States

    SUITE 260

    ADRIAN, MI 492211478

    Phone: (517) 265-4770

    Fax: (517) 265-1380

    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 49221)

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Provider's Procedures

Unknown Individual performs procedures in Urology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
UROLOGYMI55700Biopsy of prostate gland1414
UROLOGYMI76872Ultrasound of rectum1414
UROLOGYMI76942Ultrasonic guidance imaging supervision and interpretation for insertion of needle1414

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: 7012902265View full group profile
NameSpecialtyState
PAUL RICHARD III EMMONS (CRNA)
Certified Registered Nurse Anesthetist (Crna)KY
JAYCIE STAUDINGER (NP)
Nurse PractitionerMI
DAVID A GLANCY (CRNA)
Certified Registered Nurse Anesthetist (Crna)MI
JENNIFER EMILY LEWIS (CNP)
Nurse PractitionerMI
MRS. OLGA V. HALSTEAD (CRNA)
Certified Registered Nurse Anesthetist (Crna)MI
SHIMEA LYNN HUNT (PA-C)
-MI
VANESSA J PETERS (CRNA)
Certified Registered Nurse Anesthetist (Crna)MI
MRS. AMANDA MANNO
Certified Registered Nurse Anesthetist (Crna)WI
HEMLATA BHASKAR (M.D.)
Internal MedicineMI
LISA ANN SUING (CNP)
Nurse PractitionerMI

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1124087143 for Unknown Individual, then check state licensing separately.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Urology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Adrian, Michigan may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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