Unknown Individual – Family Medicine Physician, NPI 1477650265

Unknown Individual is a healthcare provider. based in Springfield, Missouri. specializing in Family Medicine Physician. They hold a License No. 102951 (MO). The NPI Number for Unknown Individual is 1477650265

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477650265
Phone
(417) 269-5712
Address
PO BOX 4046
Deactivation Date
17 July 2025

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Secondary Phone
4178473500
Graduation Year
1972 (54 years ago)
PAC ID
5991794588
Group Practice PAC ID
0345236667
Professional Enrollment ID
I20040510000242
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Springfield, Boulevard Émile Krieps, Oberkorn, Differdange, Canton Esch-sur-Alzette, 4543, Luxembourg

    SPRINGFIELD, MO 658084046

    Phone: (417) 269-5712

    Fax: (417) 269-7567

    Type: Mailing

  • Cox Health Clinic, 75, Smithson Drive, Cassville, Barry County, Missouri, 65625, United States

    SUITE A

    CASSVILLE, MO 656259429

    Phone: (417) 847-3500

    Fax: (417) 847-3523

    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.

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 65808)

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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: 0345236667View full group profile
NameSpecialtyState
-MO
-MO
Interventional Cardiology, Cardiovascular Disease (Cardiology)MO
Family PracticeMO
Interventional Cardiology, Cardiovascular Disease (Cardiology)MO
Nurse PractitionerMO
-MO
Family PracticeMO
Hospitalist, Family Practice, Family PracticeNE
Orthopedic SurgeryMO

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1477650265 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Springfield, Missouri?
If you are local to Springfield, Missouri, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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