Unknown Individual – Psychiatry Physician, NPI 1528147972

Unknown Individual is a healthcare provider. based in West plains, Missouri. specializing in Psychiatry Physician. They hold a License No. 55479 (VA). The NPI Number for Unknown Individual is 1528147972

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1528147972
Phone
(417) 256-9111
Address
PO BOX 1100
Deactivation Date
23 August 2021

Doctor Profile

Medical School Name
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
41725691116036
Graduation Year
1970 (56 years ago)
PAC ID
2365540895
Group Practice PAC ID
3870491863
Professional Enrollment ID
I20070607000310
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:0State licenses:6Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1100, Highway 11, Gowensville, Landrum, Greenville County, South Carolina, 29356, United States

    WEST PLAINS, MO 657751100

    Phone: (417) 256-9111

    Type: Mailing

  • 909, North Kentucky Avenue, West Plains, Howell County, Missouri, 65775, United States

    WEST PLAINS, MO 657752024

    Phone: (417) 257-6762

    Fax: (417) 257-5823

    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 65775)

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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: 3870491863View full group profile
NameSpecialtyState
Nurse PractitionerMO
Nurse PractitionerMO
Family PracticeMO
Physician AssistantOK
-IL
Internal Medicine, RheumatologyMO
A N E S T H E S I O L O G YMO
-MO
-IL
Nurse PractitionerAR

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1528147972 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is West Plains, Missouri in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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