Unknown Individual – Emergency Medicine Physician, NPI 1841296423

Unknown Individual is a healthcare provider. based in Neosho, Missouri. specializing in Emergency Medicine Physician. They hold a License No. 10213A (WY). The NPI Number for Unknown Individual is 1841296423

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1841296423
Phone
(620) 202-0096
Address
1400 RIDGEWOOD RD
Deactivation Date
10 April 2024

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF PENNSYLVANIA
Secondary Phone
6605622600
Graduation Year
1994 (32 years ago)
PAC ID
5698769644
Group Practice PAC ID
0446534515
Professional Enrollment ID
I20040413000069

Contacts

Secure Messaging
tpinson60800@sih.direct-ci.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness85
Years active:0State licenses:12Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 1400 RIDGEWOOD RD

    NEOSHO, MO 648501392

    Phone: (620) 202-0096

    Type: Mailing

  • 11074 MICA LN

    NEOSHO, MO 64850

    Phone: (620) 202-0096

    Type: Location

  • 2 S Hospital Dr

    Murphysboro, IL 629663333

    Phone: (618) 684-3156

    Type: Location

  • 405 W Jackson St

    Carbondale, IL 629011462

    Phone: (618) 549-0721

    Type: Location

  • 201 S 14th St

    Herrin, IL 629483631

    Phone: (618) 942-2171

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $15.

Total Amount is formed as General ($15) + Research ($0) + Ownership ($0) = $15.

Last reported payment date: 2023-05-24 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($15).

Total Amount

$15

General + Research + Ownership

Payments

1

Total payment records

General Amount

$15

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-05-24

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
GlaxoSmithKline, LLC.$15
View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making198193$0
99284Emergency department visit with moderate level of medical decision making114113$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only9591$0
99291Critical care, first 30-74 minutes4343$0
99283Emergency department visit with low level of medical decision making2726$0
View full utilization report →

Insurance plans in this area (ZIP 64850)

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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: 0446534515View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1841296423.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Neosho, Missouri in the same public data insurers reference.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.