Unknown Individual – Specialist, NPI 1578566840

Unknown Individual is a healthcare provider. based in Eagan, Minnesota. specializing in Specialist. They hold a License No. 40670 (MN). The NPI Number for Unknown Individual is 1578566840

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1578566840
Phone
(651) 209-3600
Address
1185 TOWN CENTRE DR
Deactivation Date
23 August 2023

Doctor Profile

Medical School Name
MAYO MEDICAL SCHOOL
Secondary Phone
-
Graduation Year
1994 (32 years ago)
PAC ID
8123098118
Professional Enrollment ID
I20040728000191
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

  • St. Paul Radiology, 1185, Town Centre Drive, Eagan, Dakota County, Minnesota, 55123, United States

    STE 101

    EAGAN, MN 551231188

    Phone: (651) 209-3600

    Fax: (651) 209-3601

    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)

CMS reports 2 Open Payments records for all available years, with a total value of $30.

Total Amount is formed as General ($30) + Research ($0) + Ownership ($0) = $30.

Last reported payment date: 2023-01-22 • Largest payer in this snapshot: Amgen Inc. ($17).

Total Amount

$30

General + Research + Ownership

Payments

2

Total payment records

General Amount

$30

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-01-22

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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
96910Therapy procedure using ultraviolet radiation with tar or petroleum jelly application42619$0
17003Destruction of precancer skin growth, 2-14 growths22256$0
99214Established patient office or other outpatient visit, 30-39 minutes147115$0
99213Established patient office or other outpatient visit, 20-29 minutes11398$0
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg8616$0
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Insurance plans in this area (ZIP 55123)

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Provider's Procedures

Unknown Individual performs procedures in Specialist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYMN11101Biopsy of each additional growth of skin and/or tissue1615

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1578566840?
NPI 1578566840 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Other Service Providers in the directory — Clinical services aligned with this taxonomy classification.
Where in Minnesota is Unknown Individual registered?
Use Eagan, Minnesota as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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