Unknown Individual – Nurse Practitioner, NPI 1780623082

Unknown Individual is a healthcare provider. based in Grand rapids, Michigan. specializing in Nurse Practitioner. They hold a License No. 4704163516 (MI). The NPI Number for Unknown Individual is 1780623082

Main info

Organization
Inactive
27 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780623082
Phone
Not provided
Address
100 MICHIGAN ST NE
Deactivation Date
1 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1999 (27 years ago)
PAC ID
9436104056
Group Practice PAC ID
4587568647
Professional Enrollment ID
I20050317000896
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

  • Spectrum Health Butterworth Hospital, 100, Michigan Street Northeast, Grand Rapids, Kent County, Michigan, 49503, United States

    MC845

    GRAND RAPIDS, MI 495032560

    Phone:

    Type: Mailing

  • Spectrum Health Zeeland Community Hospital, 8333, Felch Street, Zeeland Charter Township, Ottawa County, Michigan, 49464, United States

    ZEELAND, MI 494641698

    Phone: (616) 772-4644

    Fax: (616) 748-2828

    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 49503)

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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: 4587568647View full group profile
NameSpecialtyState
Critical Care (Intensivists)IL
Physician AssistantMI
Physician AssistantMI
Physician AssistantMI
-MI
Vascular SurgeryIL
-MI
-MI
A N E S T H E S I O L O G YTX
Clinical Social WorkerMI

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1780623082 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Michigan is Unknown Individual registered?
Use Grand Rapids, Michigan as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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