Unknown Individual – Emergency Medicine Physician, NPI 1164449708

Unknown Individual is a healthcare provider. based in Bonne terre, Missouri. specializing in Emergency Medicine Physician. They hold a License No. 18006 (KS). The NPI Number for Unknown Individual is 1164449708

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164449708
Phone
(573) 358-1400
Address
7245 RAIDER RD
Deactivation Date
16 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5737566792
Graduation Year
1975 (51 years ago)
PAC ID
1759445422
Group Practice PAC ID
1456254226
Professional Enrollment ID
I20090123000403
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:0State licenses:4Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Parkland Health Center-Bonne Terre, 7245, Raider Road, Bonne Terre, Saint Francois County, Missouri, 63628, United States

    BONNE TERRE, MO 636283767

    Phone: (573) 358-1400

    Type: Location

  • 75 REMITT DRIVE

    LOCKBOX 1900

    CHICAGO, IL 606751900

    Phone: (866) 916-5259

    Fax: (231) 922-4030

    Type: Mailing

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 63628)

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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: 1456254226View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1164449708 on file in the registry.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Emergency Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Bonne Terre, Missouri.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.