Unknown Individual – Internal Medicine Physician, NPI 1104806728

Unknown Individual is a healthcare provider. based in Alexandria, Minnesota. specializing in Internal Medicine Physician. They hold a License No. 021074 (MN). The NPI Number for Unknown Individual is 1104806728

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104806728
Phone
(320) 762-0399
Address
1527 BROADWAY ST
Deactivation Date
18 December 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Secondary Phone
3207620399
Graduation Year
1972 (54 years ago)
PAC ID
7113814088
Group Practice PAC ID
4284546151
Professional Enrollment ID
I20100303000749

Contacts

Secure Messaging
ftownsend4188494@direct.sanfordhealth.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 1527, Broadway Street, Alexandria, Douglas County, Minnesota, 56308, United States

    ALEXANDRIA, MN 563082537

    Phone: (320) 762-0399

    Fax: (320) 762-6847

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
93306Ultrasound of heart with color-depicted blood flow, rate, direction and valve function2315$0
View full utilization report →

Insurance plans in this area (ZIP 56308)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEMN85610Blood test, clotting time28641
INTERNAL MEDICINEMN93280Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report2316

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: 4284546151View full group profile

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1104806728.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Alexandria, Minnesota for Unknown Individual; download NPPES for the complete set.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1104806728. Always confirm identity and privileges with the practice and licensing boards.

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