Unknown Individual – Pain Medicine (Psychiatry & Neurology) Physician, NPI 1710923909

Unknown Individual is a healthcare provider. based in Minneapolis, Minnesota. specializing in Pain Medicine (Psychiatry & Neurology) Physician. They hold a License No. 54735 (MN). The NPI Number for Unknown Individual is 1710923909

Main info

Organization
Inactive
20 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710923909
Phone
(612) 273-5400
Address
606 24TH AVE S
Deactivation Date
20 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9524604900
Graduation Year
2006 (20 years ago)
PAC ID
9133390537
Group Practice PAC ID
1951213057
Professional Enrollment ID
I20110915000153
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Riverside Professional Builiding, 606, 24th Avenue South, Minneapolis, Hennepin County, Minnesota, 55454, United States

    SUITE 600

    MINNEAPOLIS, MN 554541455

    Phone: (612) 273-5400

    Fax: (612) 273-9945

    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 55454)

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Provider's Procedures

Unknown Individual performs procedures in Pain Medicine (Psychiatry & Neurology) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NEUROLOGYMN20610Aspiration and/or injection of large joint or joint capsule3124

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: 1951213057View full group profile
NameSpecialtyState
DR. JOHN PAUL BERGER (D.O.)
Pulmonary DiseaseCO
DON COLEMAN
-MN
SARAH NICOLE OLSON VENNING (LICSW)
-MN
CHARITO M SANTOS (MD)
Family PracticeMN
BREANNA PETERSON (D.O.)
-MO
LYDIA NYAKONU SHERMAN (CNP)
-MN
KELLY JEAN KILLIAN (NP)
-VA
MR. JENS PREM TAMANG (OTR)
-MN
MS. RENEE HAROLDSON (OTRL CHT)
-MN
DR. JULIE LIN BECKER (MD)
O B S T E T R I C S/ G Y N E C O L O G YMN

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1710923909; it appears in the national provider directory.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Pain Medicine (Psychiatry & Neurology) Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Minneapolis, Minnesota for Unknown Individual based on available NPPES addresses.
What if Minneapolis, Minnesota seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.