Unknown Individual – Clinical Social Worker, NPI 1043828908

Unknown Individual is a healthcare provider. based in Jefferson city, Missouri. specializing in Clinical Social Worker. They hold a License No. 2020020791 (MO). The NPI Number for Unknown Individual is 1043828908

Main info

Organization
Inactive
9 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043828908
Phone
(573) 634-5400
Address
1303 EDGEWOOD DR
Deactivation Date
18 February 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5736345400
Graduation Year
2017 (9 years ago)
PAC ID
8820413925
Group Practice PAC ID
7810900297
Professional Enrollment ID
I20200806002217
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

Provider Addresses for Unknown Individual

  • 1303 EDGEWOOD DR

    JEFFERSON CITY, MO 651091943

    Phone: (573) 634-5400

    Fax: (573) 636-2639

    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 65109)

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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: 7810900297View full group profile
NameSpecialtyState
-MO
Clinical Social WorkerMO
Clinical Social WorkerMO
Clinical Social WorkerMO

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1043828908 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Jefferson City, Missouri because that is what the record indicates for Unknown Individual.
What if Jefferson City, Missouri seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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