Unknown Individual – Psychiatry Physician, NPI 1306852017

Unknown Individual is a healthcare provider. based in Kansas city, Missouri. specializing in Psychiatry Physician. They hold a License No. 34291 (MO). The NPI Number for Unknown Individual is 1306852017

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1306852017
Phone
(816) 210-9657
Address
4709 N HOLLY CT
Deactivation Date
22 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9074593500
Graduation Year
1965 (61 years ago)
PAC ID
9234263823
Group Practice PAC ID
5698056901
Professional Enrollment ID
I20181226000802
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

  • 4709, North Holly Court, Briarcliff West Villas, Kansas City, Clay County, Missouri, 64116, United States

    KANSAS CITY, MO 641164646

    Phone: (816) 210-9657

    Fax: (816) 587-8190

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes22928$0
99238Hospital discharge day management, 30 minutes or less3126$0
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes1616$0
View full utilization report →

Insurance plans in this area (ZIP 64116)

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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: 5698056901View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)LA
Certified Registered Nurse Anesthetist (Crna)AK
A N E S T H E S I O L O G YMD
P S Y C H I A T R YWA
H O S P I T A L I S TCA
Emergency MedicineAK
U R O L O G YAK
Certified Registered Nurse Anesthetist (Crna)ID
Family PracticeAK
-AK

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1306852017?
NPI 1306852017 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Kansas City?
Public fields place Unknown Individual around Kansas City, Missouri. Always confirm the exact site before visiting.
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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