Unknown Individual – Surgery Physician, NPI 1114925823

Unknown Individual is a healthcare provider. based in Lincoln, Nebraska. specializing in Surgery Physician. They hold a License No. 21626 (NE). The NPI Number for Unknown Individual is 1114925823

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114925823
Phone
(402) 483-8590
Address
2222 S 16TH ST
Deactivation Date
21 July 2021

Doctor Profile

Medical School Name
PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
4024838444
Graduation Year
1987 (39 years ago)
PAC ID
1153389499
Group Practice PAC ID
7315915873
Professional Enrollment ID
I20050103000675
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

  • 2222, South 16th Street, Lincoln Village, Milwaukee, Milwaukee County, Wisconsin, 53215, United States

    SUITE 400A

    LINCOLN, NE 685023796

    Phone: (402) 483-8590

    Fax: (402) 483-8599

    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 68502)

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Provider's Procedures

Unknown Individual performs procedures in Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GENERAL SURGERYNE19301Partial removal of breast2219

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: 7315915873View full group profile
NameSpecialtyState
Physician AssistantNE
Physician AssistantNE
-NE
Nurse PractitionerNE
-NE
Neuropsychiatry, PsychiatryNE
Family PracticeNE
Physician AssistantNE
Physician AssistantNE
Physician AssistantNE

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1114925823 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Surgery Physician in this dataset. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Lincoln, Nebraska; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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