Unknown Individual – Cardiovascular Disease Physician, NPI 1154323970

Unknown Individual is a healthcare provider. based in Saint cloud, Minnesota. specializing in Cardiovascular Disease Physician. They hold a License No. 38836 (MN). The NPI Number for Unknown Individual is 1154323970

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154323970
Phone
(320) 252-5131
Address
1200 6TH AVE N
Deactivation Date
22 March 2022

Doctor Profile

Medical School Name
UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Secondary Phone
3202525131
Graduation Year
1986 (40 years ago)
PAC ID
4385721364
Group Practice PAC ID
2466363395
Professional Enrollment ID
I20091001000726
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

  • 1200, 6th Avenue North, St. Cloud, Stearns County, Minnesota, 56303, United States

    SAINT CLOUD, MN 563032735

    Phone: (320) 252-5131

    Fax: (320) 240-2118

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 56303)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)MN78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies6464
CARDIOVASCULAR DISEASE (CARDIOLOGY)MN93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report1111

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: 2466363395View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1154323970 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Saint Cloud, Minnesota may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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