Unknown Individual – Internal Medicine Physician, NPI 1073533170

Unknown Individual is a healthcare provider. based in Owensville, Missouri. specializing in Internal Medicine Physician. They hold a License No. 36838 (MO). The NPI Number for Unknown Individual is 1073533170

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073533170
Phone
(573) 885-1030
Address
139 ECHOLS RD
Deactivation Date
20 September 2023

Doctor Profile

Medical School Name
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
6362315623
Graduation Year
1986 (40 years ago)
PAC ID
1153320544
Group Practice PAC ID
5799782496
Professional Enrollment ID
I20061213000033
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

  • 139 ECHOLS RD

    OWENSVILLE, MO 650663411

    Phone: (573) 885-1030

    Type: Mailing

  • 233, Clarkson Road, Ellisville, Saint Louis County, Missouri, 63011, United States

    ELLISVILLE, MO 630112219

    Phone: (636) 256-8644

    Type: Location

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 65066)

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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: 5799782496View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1073533170 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Owensville, Missouri as the reference point for Unknown Individual, then confirm.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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