Unknown Individual – Cognitive & Behavioral Psychologist, NPI 1003987983

Unknown Individual is a healthcare provider. based in Minneapolis, Minnesota. specializing in Cognitive & Behavioral Psychologist. They hold a License No. LP4340 (MN). The NPI Number for Unknown Individual is 1003987983

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003987983
Phone
Not provided
Address
300 CHICAGO AVE
Deactivation Date
22 February 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6128634495
Graduation Year
2000 (26 years ago)
PAC ID
6800968793
Group Practice PAC ID
4587573613
Professional Enrollment ID
I20080709000723

Contacts

Secure Messaging
mmcallister204995@excellian.direct.allina.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 300, Chicago Avenue South, Downtown East, Central, Minneapolis, Hennepin County, Minnesota, 55415, United States

    MINNEAPOLIS, MN 55407

    Phone:

    Type: Mailing

  • Abbott Northwestern Hospital, 800, East 28th Street, Midtown Phillips, Phillips, Minneapolis, Hennepin County, Minnesota, 55407, United States

    MINNEAPOLIS, MN 554073723

    Phone: (612) 863-4495

    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 55407)

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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: 4587573613View full group profile
NameSpecialtyState
DR. JOHN PAUL BERGER (D.O.)
Pulmonary DiseaseCO
DR. JULIA BRADEN REITZ (AU.D.)
Qualified AudiologistMN
EMILY FUNK (M.D.)
Family PracticeMN
EFRAT EICHENBAUM (LP, PHD)
-MN
DR. DAVID SHRAKE (D.O.)
Family PracticeMN
SADIE MARIE NELSON (APRN, CNP)
Nurse PractitionerND
JEFFREY C. MANLOVE (M.D.)
-MN
DR. ROBIN D MCALLISTER (MD)
-MN
Unknown Individual
-MN
LOIS A KUBITSCHEK (GNP)
-MN

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1003987983?
NPI 1003987983 belongs to Unknown Individual; compare other details if you need extra assurance.
Does inactive status mean Unknown Individual stopped practicing?
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 Cognitive & Behavioral Psychologist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Minneapolis?
Public fields place Unknown Individual around Minneapolis, Minnesota. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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