Unknown Individual – Diagnostic Radiology Physician, NPI 1235119827

Unknown Individual is a healthcare provider. based in Eden prairie, Minnesota. specializing in Diagnostic Radiology Physician. They hold a License No. 0101043315 (VA). The NPI Number for Unknown Individual is 1235119827

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1235119827
Phone
(952) 595-1301
Address
11995 SINGLETREE LN STE 500
Deactivation Date
19 July 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9525951100
Graduation Year
1981 (45 years ago)
PAC ID
8628216496
Group Practice PAC ID
4981608817
Professional Enrollment ID
I20180219000370
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

Provider Addresses for Unknown Individual

  • 11995 SINGLETREE LN STE 500

    EDEN PRAIRIE, MN 553445349

    Phone: (952) 595-1301

    Fax: (612) 294-4903

    Type: Mailing

  • 114 EDWARD WYATT DR

    WILLIAMSBURG, VA 231886439

    Phone: (952) 595-1100

    Fax: (612) 294-4903

    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.

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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 55344)

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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: 4981608817View full group profile
NameSpecialtyState
Diagnostic RadiologySC
-SC
-MN
-MN
Diagnostic RadiologyNY
-MN
Diagnostic RadiologyTN
Diagnostic RadiologyMN
Diagnostic RadiologyMN
Diagnostic Radiology, Nuclear MedicineCO

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1235119827.
Why might Unknown Individual appear inactive while still practicing?
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 Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Eden Prairie, Minnesota in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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