Unknown Individual – Family Nurse Practitioner, NPI 1003205576

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Crestline, Ohio. specializing in Family Nurse Practitioner. They hold a License No. COA.16997-NP (OH). The NPI Number for Unknown Individual is 1003205576

Main info

Organization

Inactive

12 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1003205576

Phone

(419) 468-0935

Address

700 N COLUMBUS ST

Deactivation Date

12 June 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

4195339855

Graduation Year

2014 (12 years ago)

PAC ID

4981920659

Group Practice PAC ID

3274437082

Professional Enrollment ID

I20150225000460

Contacts

Secure Messaging

lfagan484657@direct.osumc.edu

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

700 N COLUMBUS ST
CRESTLINE, OH 448271455
Phone: (419) 468-0935
Fax: (419) 462-5372
Type: Mailing
139 GAIUS ST
BUCYRUS, OH 448201508
Phone: (419) 563-9855
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 $14.

Total Amount is formed as General ($14) + Research ($0) + Ownership ($0) = $14.

Last reported payment date: 2023-09-01 • Largest payer in this snapshot: Pharmacyclics LLC, an AbbVie Company ($14).

Total Amount

$14

General + Research + Ownership

Payments

Total payment records

General Amount

$14

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2023-09-01

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
Pharmacyclics LLC, an AbbVie Company	$14

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44827)

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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: 3274437082View full group profile

Name	Specialty	State
MRS. JULIE ELIZABETH BURKHART (APRN, NP-C)	Nurse Practitioner	OH
MIRIAM ROGGIO (APRN, CNP)	Nurse Practitioner	OH
JESSICA M HANNAN (NP)	-	OH
WILLIAM J POLINSKI (DO PHD FACC)	Cardiovascular Disease (Cardiology), Cardiac Electrophysiology, Internal Medicine	OH
CYNTHIA A DORSEY (MD)	E N D O C R I N O L O G Y	OH
ERNEST CHARLES GUMPRECHT (MD)	Cardiovascular Disease (Cardiology), Internal Medicine	OH
KATHLEEN L SCHOMER (DO)	Emergency Medicine	OH
MR. JAMES W SPIRES (CRNA)	-	OH
MR. JAMES A II GOUDY (MD)	Internal Medicine	OH
VLADIMIR FABIAN (MD)	Hospitalist, Internal Medicine	OH

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?

CMS-hosted NPPES data lists Unknown Individual with NPI 1003205576.

Why might Unknown Individual appear inactive while still practicing?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Crestline, Ohio as a primary anchor for Unknown Individual unless the record lists multiple sites.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."