Unknown Individual – Family Medicine Physician, NPI 1487623245

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Richmond, Missouri. specializing in Family Medicine Physician. They hold a License No. R2F86 (MO). The NPI Number for Unknown Individual is 1487623245

Main info

Organization

Inactive

44 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1487623245

Phone

(816) 776-2201

Address

902 WOLLARD BLVD

Deactivation Date

9 February 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8167722201

Graduation Year

1982 (44 years ago)

PAC ID

6204825912

Group Practice PAC ID

6305748153

Professional Enrollment ID

I20041021000628

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

902, Wollard Boulevard, Richmond, Ray County, Missouri, 64085, United States
RICHMOND, MO 640852229
Phone: (816) 776-2201
Fax: (816) 480-4515
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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 64085)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	MO	81002	Urinalysis, manual test	70	50

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: 6305748153View full group profile

Name	Specialty	State
STEPHANIE ANNE MEYER (NP)	Nurse Practitioner	MO
DR. AVERY THOMAS ABERNATHY (D.O.)	Family Practice, Osteopathic Manipulative Medicine	MO
SANDRA EGGERS (FNP-BC)	-	MO
BRUCE W DURKEE (MD)	-	MO
CHRISTOPHER AVILA (MD)	Hospitalist, Internal Medicine	MO
LAURA B CONTRERAS (DNP)	Nurse Practitioner	MO
CASSANDRA A BOEHNING (FNP-C)	Nurse Practitioner	DE
DR. JON S GENGLER (MD)	General Surgery	MO
DR. SHANNON KOHAKE (MD)	N E U R O L O G Y	MO
NICOLAS PATONAI (M.D.)	A N E S T H E S I O L O G Y	MO