Unknown Individual – Family Medicine Physician, NPI 1033198759

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Lewistown, Missouri. specializing in Family Medicine Physician. They hold a License No. R1E22 (MO). The NPI Number for Unknown Individual is 1033198759

Main info

Organization

Inactive

43 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1033198759

Phone

(573) 215-2715

Address

105 E QUINCY ST

Deactivation Date

13 March 2024

Doctor Profile

Medical School Name

AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE

Secondary Phone

2172226550

Graduation Year

1983 (43 years ago)

PAC ID

7012913866

Group Practice PAC ID

0749192375

Professional Enrollment ID

I20100514000059

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

105, Quincy Street, Lewistown, Lewis County, Missouri, 63452, United States
LEWISTOWN, MO 634522560
Phone: (573) 215-2715
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 63452)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	MO	81002	Urinalysis, manual test	24	20
FAMILY MEDICINE	MO	85610	Blood test, clotting time	118	22

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: 0749192375View full group profile

Name	Specialty	State
BRANDI N. RUZICH (PHYSICAL THERAPIST)	-	IL
DR. ERIN MJ SHEFFIELD (D.D.S.)	Oral Surgery	IA
KATELYN M. FESSENDEN	Nurse Practitioner	IL
TIMOTHY W. JACOBS (D.O.)	-	IL
CHERYL KRUS	Mental Health Counselor	IL
Unknown Individual	-	IL
MATTHEW T. BRINK (DO)	Family Practice	IL
ELIZABETH TERWELP (PA-C)	Physician Assistant	IL
DR. KENT RANDALL WOLBER (O.D.)	-	IL
ERIC A SIECK (MD)	O P H T H A L M O L O G Y	IL

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?

NPI 1033198759 is assigned to Unknown Individual under the national enumeration system.

Is Unknown Individual's inactive status permanent?

An inactive NPI does not by itself prove someone stopped practicing — check other sources.

Does Unknown Individual list a primary specialty?

If you are matching referrals, note Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.

What location metadata exists for Unknown Individual?

The page summarizes Lewistown, Missouri for Unknown Individual; expand the address list for detail.

Is Unknown Individual a real provider?

This page reflects official NPPES data for NPI 1033198759. Always confirm identity and privileges with the practice and licensing boards.

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