Unknown Individual – Adult Medicine Physician, NPI 1578628657

Adult Medicine Physician

Unknown Individual is a healthcare provider. based in Reno, Nevada. specializing in Adult Medicine Physician. They hold a License No. OP60354605 (WA). The NPI Number for Unknown Individual is 1578628657

Main info

Organization

Inactive

53 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1578628657

Phone

(775) 982-4590

Address

780 KUENZLI ST

Deactivation Date

27 February 2025

Doctor Profile

Medical School Name

MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE

Secondary Phone

3603579392

Graduation Year

1973 (53 years ago)

PAC ID

4284626656

Group Practice PAC ID

1557259827

Professional Enrollment ID

I20171012001170

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience24

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

780, Kuenzli Street, Reno, Washoe County, Nevada, 89502, United States
STE 202
RENO, NV 895020837
Phone: (775) 982-4590
Fax: (775) 982-4595
Type: Mailing
Limited Lane Northwest, Olympia, Thurston County, Washington, 98504, United States
OLYMPIA, WA 985022704
Phone: (360) 357-9392
Fax: (360) 357-9485
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99213	Established patient office or other outpatient visit, 20-29 minutes	78	40	$0
99203	New patient office or other outpatient visit, 30-44 minutes	32	32	$0
36415	Insertion of needle into vein for collection of blood sample	20	18	$0

View full utilization report →

Insurance plans in this area (ZIP 89502)

Loading plans...

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: 1557259827View full group profile