Unknown Individual – Diagnostic Radiology Physician, NPI 1255438693

Diagnostic Radiology Physician

Unknown Individual is a healthcare provider. based in Eden prairie, Minnesota. specializing in Diagnostic Radiology Physician. They hold a License No. D38482 (MD). The NPI Number for Unknown Individual is 1255438693

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1255438693

Phone

(952) 595-1301

Address

11995 SINGLETREE LN STE 500

Deactivation Date

4 December 2025

Doctor Profile

Medical School Name

ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Secondary Phone

9525951100

Graduation Year

1979 (47 years ago)

PAC ID

5890971170

Group Practice PAC ID

1254327950

Professional Enrollment ID

I20180312000167

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital 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: Location
28, Mela Lane, Rancho Palos Verdes, Los Angeles County, California, 90275, United States
RANCHO PALOS VERDES, CA 902755085
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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
71045	X-ray of chest, 1 view	13	13	$0

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Insurance plans in this area (ZIP 55344)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
DIAGNOSTIC RADIOLOGY	MD	71010	X-ray of chest, 1 view, front	289	271
DIAGNOSTIC RADIOLOGY	MD	71250	CT scan chest	13	13
DIAGNOSTIC RADIOLOGY	MD	74177	CT scan of abdomen and pelvis with contrast	34	34

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: 1254327950View full group profile

Name	Specialty	State
DR. ELIZABETH LEONARD KIM (M.D.)	Diagnostic Radiology	MD
ANURADHA BHASIN (MD)	-	MD
NANCY YUE (MD)	Diagnostic Radiology	MD
ALEXANDER H MACARTHUR (MD)	Diagnostic Radiology	MD
EDWARD S OH (M.D.)	Diagnostic Radiology	AZ
DONNA T DECOSTA (MD)	Diagnostic Radiology	MD
BIJAN KERAMATI (MD)	Diagnostic Radiology	MD
MARGARET A LYNCH NYHAN (MD)	Diagnostic Radiology	MD
CHARUL P SAINI (MD)	Diagnostic Radiology	MD
DR. BRIAN MARK MONROE (M.D.)	Diagnostic Radiology, Interventional Radiology	MD