Unknown Individual – Pediatric Allergy/Immunology Physician, NPI 1114937711

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Pediatric Allergy/Immunology Physician. They hold a License No. R7132 (MO). The NPI Number for Unknown Individual is 1114937711

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114937711
Phone
(314) 268-4014
Address
1465 S GRAND BLVD
Deactivation Date
29 January 2026

Doctor Profile

Medical School Name
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3145775641
Graduation Year
1975 (51 years ago)
PAC ID
6709978398
Group Practice PAC ID
8022921964
Professional Enrollment ID
I20070828000351
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • SSM Health Cardinal Glennon Children’s Hospital, 1465, South Grand Boulevard, Tiffany, City of Saint Louis, Missouri, 63104, United States

    SAINT LOUIS, MO 631041003

    Phone: (314) 268-4014

    Fax: (314) 577-5398

    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)

CMS reports 5 Open Payments records for all available years, with a total value of $171.

Total Amount is formed as General ($171) + Research ($0) + Ownership ($0) = $171.

Last reported payment date: 2024-05-01 • Largest payer in this snapshot: CSL Behring ($85).

Total Amount

$171

General + Research + Ownership

Payments

5

Total payment records

General Amount

$171

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-01

Latest reported date

Top Companies

Largest payers in this snapshot

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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 63104)

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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: 8022921964View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1114937711 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Pediatric Allergy/Immunology Physician. Clinical services aligned with this taxonomy classification.
Where in Missouri is Unknown Individual registered?
Use Saint Louis, Missouri as the headline location for Unknown Individual here.
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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