Unknown Individual – Family Medicine Physician, NPI 1053547539

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Family Medicine Physician. They hold a License No. 2015017953 (MO). The NPI Number for Unknown Individual is 1053547539

Main info

Organization
Inactive
20 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053547539
Phone
(314) 925-4741
Address
1035 BELLEVUE AVE
Deactivation Date
26 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3146446161
Graduation Year
2006 (20 years ago)
PAC ID
8628228186
Group Practice PAC ID
6608776299
Professional Enrollment ID
I20150722005422

Contacts

Secure Messaging
rvasireddy148564@direct-ehr-ssmhc.com
FHIR Endpoint
https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Loading map...

Provider Addresses for Unknown Individual

  • 1035 Medical Building, 1035, Bellevue Avenue, Richmond Heights, Saint Louis County, Missouri, 63117, United States

    SUITE 305

    SAINT LOUIS, MO 631171854

    Phone: (314) 925-4741

    Fax: (314) 925-4754

    Type: Mailing

  • PO BOX 955534

    SAINT LOUIS, MO 631955534

    Phone:

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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
99214Established patient office or other outpatient visit, 30-39 minutes14291$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit5959$0
99213Established patient office or other outpatient visit, 20-29 minutes1715$0
View full utilization report →

Insurance plans in this area (ZIP 63117)

Loading plans...

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: 6608776299View full group profile
NameSpecialtyState
DR. ADAM WINSTON TAVES (MD)
Diagnostic RadiologyMO
ALINA V ADAMS (NP)
-MO
DEBRA E SOLOM (A.N.P.)
Nurse PractitionerMO
MR. BLESSING KUDAKWASHE TUPIRI (PA)
Physician AssistantMO
DR. STEVEN B LIVINGSTONE (D.O.)
-MO
JENNIFER ALONZO DORIMAN (ANP)
Nurse PractitionerMO
LAURA HOWARD
-MO
ANNE USHA JACOB (M.B.B.S.)
-MO
DR. ERIC NALAGAN (M.D.)
-MO
DR. MICHAEL SCOTT BOEDEFELD (MD)
Interventional Pain Management, AnesthesiologyMO

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1053547539 when you need to reference Unknown Individual in forms, claims, or directories.
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.
Where is Unknown Individual's primary listing?
We display Saint Louis, Missouri because that is what the record indicates for Unknown Individual.
What if Saint Louis, Missouri seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

Similar Providers

DR. HEATHER CAROLYN WILLIAMSON (DO)

Family Medicine Physician
670, Mason Ridge Center Drive, Town and Country, Saint Louis County, Missouri, 63141, United States
NPI: 1700880358

JON KEVIN RICHTER (MD)

Family Medicine Physician
Main, Berryville, Carroll County, Arkansas, 72616, United States
NPI: 1093710113

ALYWIN E KLUTTZ (M.D.)

Family Medicine Physician
PO BOX 504274
NPI: 1538165063

VANI PACHALLA (M.D.)

Family Medicine Physician
1717, Biddle Street, Carr Square, City of Saint Louis, Missouri, 63106, United States
NPI: 1063418382

DR. THOMAS PATRICK KUCIEJCZYK-KERNAN (M.D.)

Family Medicine Physician
1717, Biddle Street, Carr Square, City of Saint Louis, Missouri, 63106, United States
NPI: 1669478970

DAVID P RAWDON (MD)

Family Medicine Physician
660 MASON RIDGE CENTER DR STE 300
NPI: 1376549139

DR. CHAD J. SMITH (D.O.)

Family Medicine Physician
605 E Booneslick Rd
NPI: 1982600615

IAN LESTER FAWKS (DO)

Family Medicine Physician
Cox Medical Center South, 3801, South National Avenue, Springfield, Greene County, Missouri, 65807, United States
NPI: 1386640910

DR. ALEXANDER K MAMMEN (M.D.)

Family Medicine Physician
Lemay Wok, 4530, US Highway 61, Mehlville, Saint Louis County, Missouri, 63129, United States
NPI: 1609874734