Unknown Individual – Pediatric Nephrology Physician, NPI 1649296963

Unknown Individual is a healthcare provider. based in Saint louis, Missouri. specializing in Pediatric Nephrology Physician. They hold a License No. 103652 (MO). The NPI Number for Unknown Individual is 1649296963

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1649296963
Phone
(314) 454-6043
Address
1 CHILDRENS PL
Deactivation Date
21 October 2023

Doctor Profile

Medical School Name
CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Secondary Phone
-
Graduation Year
1989 (37 years ago)
PAC ID
2961531801
Group Practice PAC ID
9830008770
Professional Enrollment ID
I20100602000425

Contacts

FHIR Endpoint
https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Saint Louis Childrens Hospital School, 1, Children's Place, Central West End, City of Saint Louis, Missouri, 63110, United States

    MSC 8515-87-1200

    SAINT LOUIS, MO 631101002

    Phone: (314) 454-6043

    Fax: (888) 463-6898

    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 63110)

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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: 9830008770View full group profile

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1649296963.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Pediatric Nephrology Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Saint Louis, Missouri in registry-derived data.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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