Unknown Individual – Physician Assistant, NPI 1164406914

Unknown Individual is a healthcare provider. based in Brainerd, Minnesota. specializing in Physician Assistant. They hold a License No. 9340 (MN). The NPI Number for Unknown Individual is 1164406914

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164406914
Phone
(218) 828-7182
Address
2024 S 6TH ST
Deactivation Date
23 May 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6127758927
Graduation Year
1997 (29 years ago)
PAC ID
4082799879
Group Practice PAC ID
4587573613
Professional Enrollment ID
I20080304000214

Contacts

Secure Messaging
rheimark95670@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

  • 2024, South 6th Street, Brainerd, Minnesota, 56401, United States

    BRAINERD, MN 564014529

    Phone: (218) 828-7182

    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 56401)

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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

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1164406914.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Physician Assistant. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Brainerd, Minnesota as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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