Unknown Individual – Primary Care Nurse Practitioner, NPI 1649635772

Unknown Individual is a healthcare provider. based in Essexville, Michigan. specializing in Primary Care Nurse Practitioner. They hold a License No. 4704082850 (MI). The NPI Number for Unknown Individual is 1649635772

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1649635772
Phone
(989) 892-7722
Address
1003 WOODSIDE AVE
Deactivation Date
13 October 2023

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
9896317110
Graduation Year
1996 (30 years ago)
PAC ID
7911289970
Group Practice PAC ID
8628040680
Professional Enrollment ID
I20170126002296
Data current as of
20 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

  • 1003 WOODSIDE AVE

    ESSEXVILLE, MI 487321234

    Phone: (989) 892-7722

    Fax: (989) 892-7455

    Type: Mailing

  • 4615 EASTMAN AVE

    MIDLAND, MI 486402610

    Phone: (989) 631-7110

    Fax: (989) 631-7210

    Type: Location

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 48732)

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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: 8628040680View full group profile
NameSpecialtyState
DR. RONALD KOEHLER (DO)
-MI
PATRICIA GABLE (FNP)
-MI
DR. JOSE C MAGNO (MD)
-MI

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1649635772 for Unknown Individual, then check state licensing separately.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Primary Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Essexville, Michigan in the data we show; additional addresses may exist on the full record.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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