Unknown Individual – Family Medicine Physician, NPI 1689646358
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for Unknown Individual
1007, South Polk Street, Maysville, Camden Township, DeKalb County, Missouri, 64469, United States
MAYSVILLE, MO 644694030
Phone: (816) 449-2123
Fax: (816) 449-2125
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $178.
Total Amount is formed as General ($178) + Research ($0) + Ownership ($0) = $178.
Last reported payment date: 2024-11-11 • Largest payer in this snapshot: Mylan Specialty L.P. ($42).
Total Amount
$178
General + Research + Ownership
Payments
9
Total payment records
General Amount
$178
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Mylan Specialty L.P. | $42 |
| Lilly USA, LLC | $37 |
| AstraZeneca Pharmaceuticals LP | $29 |
| PFIZER INC. | $20 |
| Merck Sharp & Dohme LLC | $19 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040313000443 | I | General Practice | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 169 | 64 | $0 |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 122 | 44 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 96 | 89 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 68 | 67 | $0 |
| 99282 | Emergency department visit with straightforward medical decision making | 62 | 59 | $0 |
Insurance plans in this area (ZIP 64469)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MO | |
| - | MO | |
| Nurse Practitioner | MO | |
| - | MO | |
| N E U R O L O G Y | MO | |
| - | MO | |
| Certified Registered Nurse Anesthetist (Crna) | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.