Unknown Individual – Allergy & Immunology Physician, NPI 1497755243

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Allergy & Immunology Physician. They hold a License No. 27550 (MO). The NPI Number for Unknown Individual is 1497755243

Main info

Organization
Inactive
66 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1497755243
Phone
(314) 872-7958
Address
621 S NEW BALLAS RD
Deactivation Date
31 July 2024

Doctor Profile

Medical School Name
ST. LOUIS COLLEGE OF PHYSICIANS AND SURGEONS
Secondary Phone
-
Graduation Year
1960 (66 years ago)
PAC ID
2860582020
Professional Enrollment ID
I20071212000442
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

  • 621, South New Ballas Road, Creve Coeur, Saint Louis County, Missouri, 63141, United States

    STE 368

    SAINT LOUIS, MO 631418232

    Phone: (314) 872-7958

    Fax: (314) 872-7938

    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 63141)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1497755243 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Allergy & Immunology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Saint Louis?
Public fields place Unknown Individual around Saint Louis, Missouri. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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