Unknown Individual – Nephrology Physician, NPI 1114064375

Unknown Individual is a healthcare provider. based in North kansas city, Missouri. specializing in Nephrology Physician. They hold a License No. N7461 (TX). The NPI Number for Unknown Individual is 1114064375

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114064375
Phone
(816) 474-9353
Address
2790 CLAY EDWARDS DR STE 410
Deactivation Date
31 May 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8166372685
Graduation Year
2000 (26 years ago)
PAC ID
9638340771
Group Practice PAC ID
9931012820
Professional Enrollment ID
I20110921000073
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2790 CLAY EDWARDS DR STE 410

    NORTH KANSAS CITY, MO 641163274

    Phone: (816) 474-9353

    Fax: (816) 474-3627

    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 64116)

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Provider's Procedures

Unknown Individual performs procedures in Nephrology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NEPHROLOGYMO90935Hemodialysis procedure with one physician evaluation3324
NEPHROLOGYMO90961Dialysis services (2-3 physician visits per month), patient 20 years of age and older17955

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: 9931012820View full group profile
NameSpecialtyState
Nurse PractitionerMO
Nurse PractitionerMO
Nurse PractitionerMO
Nephrology, Internal MedicineKS
Nurse PractitionerMO
N E P H R O L O G YKS
N E P H R O L O G YIL
Nurse PractitionerIA
N E P H R O L O G YMO
Nurse PractitionerMO

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1114064375.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Nephrology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is North Kansas City, Missouri in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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