Unknown Individual – Hospitalist Physician, NPI 1124090220

Hospitalist Physician

Unknown Individual is a healthcare provider. based in Mankato, Minnesota. specializing in Hospitalist Physician. They hold a License No. 35184 (MN). The NPI Number for Unknown Individual is 1124090220

Main info

Organization

Inactive

36 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124090220

Phone

(507) 625-4031

Address

1025 Marsh St

Deactivation Date

25 October 2023

Doctor Profile

Medical School Name

MAYO MEDICAL SCHOOL

Secondary Phone

5207958188

Graduation Year

1990 (36 years ago)

PAC ID

1355549494

Group Practice PAC ID

9638457013

Professional Enrollment ID

I20180123002828

Contacts

Secure Messaging

kcampbell271015@ehrdirect.mayoclinicmsg.org

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience37

Completeness85

Years active:0State licenses:3Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

1025 Marsh St
Mankato, MN 560014752
Phone: (507) 625-4031
Type: Location
PO BOX 31235
TUCSON, AZ 857511235
Phone: (520) 324-4100
Type: Mailing
5301 E GRANT RD
TUCSON, AZ 857122805
Phone: (651) 210-3621
Type: Location
403, Stageline Road, Town of Hudson, Saint Croix County, Wisconsin, 54016, United States
HUDSON, WI 540167848
Phone: (715) 531-6800
Fax: (715) 531-6801
Type: Mailing

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 56001)

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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: 9638457013View full group profile

Name	Specialty	State
DR. BASEL SKEIF (M.D.)	Nuclear Medicine, Cardiovascular Disease (Cardiology)	AZ
RICHARD A ASHLEY (M.D.)	U R O L O G Y	AZ
MRS. KRISTY BELONE (FNP-C)	Nurse Practitioner	AZ
COLEMAN WADE II DAVIDSON (M.D.)	-	AZ
BRENDYN C. THE (FNP)	-	AZ
CANDICE NELSON LEWIS (M.D.)	Gynecological Oncology, Hematology/Oncology	TX
GLORIAJEAN NELSON (FNP-C, CWOCN)	-	AZ
RYAN MARTINEZ (MD, MPH)	Internal Medicine	AZ
MRS. SABINA MIAN (MD)	Rheumatology, Internal Medicine	AZ
MS. AMANDA CELESTE GARCIA (FNP-C)	Nurse Practitioner	AZ

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1124090220 for Unknown Individual.

What happens when Unknown Individual's NPI is not active?

Public data lists Unknown Individual outside the active bucket for this identifier.

What type of care does Unknown Individual provide?

Unknown Individual's profile centers on Hospitalist Physician. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Mankato, Minnesota in registry-derived data.

Who maintains Unknown Individual's record?

Providers certify NPPES data; CMS hosts the public file you are viewing.

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