Unknown Individual – Rehabilitation Psychologist, NPI 1417164542

Unknown Individual is a healthcare provider. based in Grand rapids, Michigan. specializing in Rehabilitation Psychologist. They hold a License No. 6301013224 (MI). The NPI Number for Unknown Individual is 1417164542

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417164542
Phone
(616) 940-0040
Address
1490 E BELTLINE AVE SE
Deactivation Date
9 May 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6053622617
Graduation Year
2005 (21 years ago)
PAC ID
1850452806
Group Practice PAC ID
7810212255
Professional Enrollment ID
I20150312001493
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

  • 1490, East Beltline Avenue Southeast, Third Ward, Grand Rapids, Kent County, Michigan, 49506, United States

    GRAND RAPIDS, MI 495064336

    Phone: (616) 940-0040

    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 49506)

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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: 7810212255View full group profile
NameSpecialtyState
-SD

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1417164542.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Rehabilitation Psychologist in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Grand Rapids, Michigan as the reference point for Unknown Individual, then confirm.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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