Unknown Individual – Urology Physician, NPI 1770691685

Unknown Individual is a healthcare provider. based in Chesterfield, Missouri. specializing in Urology Physician. They hold a License No. 33593 (MO). The NPI Number for Unknown Individual is 1770691685

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1770691685
Phone
(314) 434-6130
Address
224 S WOODS MILL RD
Deactivation Date
10 May 2023

Doctor Profile

Medical School Name
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3147419010
Graduation Year
1971 (55 years ago)
PAC ID
4981600533
Group Practice PAC ID
6204723786
Professional Enrollment ID
I20100329000640
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

  • 224, South Woods Mill Road, Chesterfield, Saint Louis County, Missouri, 63017, United States

    STE 309E

    CHESTERFIELD, MO 630173451

    Phone: (314) 434-6130

    Fax: (314) 434-1277

    Type: Mailing

  • 11155, Dunn Road, Saint Louis County, Missouri, 63136, United States

    STE 309E

    SAINT LOUIS, MO 631366150

    Phone: (314) 741-9010

    Fax: (314) 741-5102

    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 63017)

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Provider's Procedures

Unknown Individual performs procedures in Urology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
UROLOGYMO51798Ultrasound measurement of bladder capacity after voiding306211
UROLOGYMO76872Ultrasound of rectum2121

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: 6204723786View full group profile
NameSpecialtyState
Nurse PractitionerKS
N E U R O S U R G E R YMO
Physician AssistantIL
Physician AssistantOK
N E U R O S U R G E R YMO
-MO
Qualified AudiologistMO
Nurse PractitionerMO
U R O L O G YMO
Otolaryngology, Plastic And Reconstructive SurgeryMO

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1770691685.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Urology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Chesterfield, Missouri because that is what the record indicates for Unknown Individual.
What if Chesterfield, Missouri seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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