Unknown Individual – Diagnostic Radiology Physician, NPI 1285694364

Unknown Individual is a healthcare provider. based in Eden prairie, Minnesota. specializing in Diagnostic Radiology Physician. They hold a License No. 34.013650 (OH). The NPI Number for Unknown Individual is 1285694364

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1285694364
Phone
(952) 595-1301
Address
11995 SINGLETREE LN STE 500
Deactivation Date
30 August 2023

Doctor Profile

Medical School Name
DES MOINES UNIVERSITY OF OSTEOPATHIC MEDICINE AND HEALTH SCIENCES
Secondary Phone
8172356561
Graduation Year
1995 (31 years ago)
PAC ID
1456254721
Group Practice PAC ID
7113024480
Professional Enrollment ID
I20040202000826
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: Mailing

  • 1101, 6th Avenue, Fairmount, Fort Worth, Tarrant County, Texas, 76101, United States

    FORT WORTH, TX 761044306

    Phone: (817) 336-4638

    Fax: (817) 336-7637

    Type: Mailing

  • 5100, North Branch Drive, Fort Worth, Tarrant County, Texas, 76132, United States

    FORT WORTH, TX 761323745

    Phone: (817) 235-6561

    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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
71045X-ray of chest, 1 view660583$0
77067Screening mammography311311$0
71046X-ray of chest, 2 views246239$0
77063Screening 3d breast mammography188188$0
70450Ct scan head or brain without contrast141133$0
View full utilization report →

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.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYTX71250CT scan chest9390
DIAGNOSTIC RADIOLOGYTX73110X-ray of wrist, minimum of 3 views1817
DIAGNOSTIC RADIOLOGYTX73562X-ray of knee, 3 views1818
DIAGNOSTIC RADIOLOGYTX74177CT scan of abdomen and pelvis with contrast7474
DIAGNOSTIC RADIOLOGYTX93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers2828

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: 7113024480View full group profile
NameSpecialtyState
Diagnostic Radiology, Interventional RadiologyTX
Diagnostic RadiologyWV
-OH
-OH

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1285694364 — is the standard way to identify this listing.
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 taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Diagnostic Radiology Physician in this dataset. 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.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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