Unknown Individual – Podiatrist, NPI 1336593102

Unknown Individual is a healthcare provider. based in Joplin, Missouri. specializing in Podiatrist. They hold a License No. 2019034793 (MO). The NPI Number for Unknown Individual is 1336593102

Main info

Organization
Inactive
10 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1336593102
Phone
(620) 762-0800
Address
2630 Cunningham Ave
Deactivation Date
6 September 2023

Doctor Profile

Medical School Name
NEW YORK COLLEGE OF PODIATRIC MEDICINE
Secondary Phone
4177827500
Graduation Year
2016 (10 years ago)
PAC ID
9537405741
Group Practice PAC ID
3274535414
Professional Enrollment ID
I20200506002218
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 2630 Cunningham Ave

    Joplin, MO 648041542

    Phone: (620) 762-0800

    Fax: (417) 782-7524

    Type: Location

  • FIRST AVENUE AT 16TH STREET

    NEW YORK, NY 10003

    Phone: (212) 420-2000

    Type: Mailing

  • 201, South Maiden Lane, Joplin, Jasper County, Missouri, 64801, United States

    JOPLIN, MO 648040319

    Phone: (417) 782-7500

    Type: Location

  • PO BOX 3592

    JOPLIN, MO 648033592

    Phone: (417) 782-7500

    Fax: (417) 782-7524

    Type: Mailing

  • 2630 CUNNINGHAM AVE

    JOPLIN, MO 648041542

    Phone: (417) 782-7500

    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.

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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
99213Established patient office or other outpatient visit, 20-29 minutes180112$0
11721Removal of fingernails or toenails, 6 or more nails142103$0
11056Removal of noncancer thickened skin growth, 2-4 growths139101$0
99203New patient office or other outpatient visit, 30-44 minutes2525$0
73630X-ray of foot, minimum of 3 views1915$0
View full utilization report →

Insurance plans in this area (ZIP 64804)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1336593102 if you need a stable reference for Unknown Individual.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What kind of provider is Unknown Individual?
The page reflects Podiatrist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Joplin, Missouri for Unknown Individual; expand the address list for detail.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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