Unknown Individual – Hospitalist Physician, NPI 1083791529

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Hospitalist Physician. They hold a License No. 108866 (MO). The NPI Number for Unknown Individual is 1083791529

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083791529
Phone
(314) 996-5772
Address
670 MASON RIDGE CENTER DR
Deactivation Date
26 October 2021

Doctor Profile

Medical School Name
ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
Secondary Phone
3142730195
Graduation Year
1980 (46 years ago)
PAC ID
5597758516
Group Practice PAC ID
3072421254
Professional Enrollment ID
I20040406000743

Contacts

FHIR Endpoint
https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

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Provider Addresses for Unknown Individual

  • Mason Ridge Center Drive, Town and Country, Saint Louis County, Missouri, 63141, United States

    SUITE 300

    SAINT LOUIS, MO 631418573

    Phone: (314) 996-5772

    Fax: (314) 996-7691

    Type: Mailing

  • Missouri Baptist Medical Center, 3015, North Ballas Road, Town and Country, Saint Louis County, Missouri, 63131, United States

    SAINT LOUIS, MO 631312329

    Phone: (314) 996-5772

    Fax: (314) 996-7691

    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 63141)

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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: 3072421254View full group profile
NameSpecialtyState
-MO
-MO
Family PracticeMO
Hospitalist, Family PracticeMO
Internal MedicineMO
-MO
Family PracticeMO
Internal MedicineIL
Internal Medicine, HospitalistMO
Nurse PractitionerMO

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1083791529?
NPI 1083791529 belongs to Unknown Individual; compare other details if you need extra assurance.
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 Hospitalist Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Saint Louis?
Unknown Individual currently maps to Saint Louis, Missouri in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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