Unknown Individual – Urology Physician, NPI 1104801869

Unknown Individual is a healthcare provider. based in Toledo, Ohio. specializing in Urology Physician. They hold a License No. 35051590 (OH). The NPI Number for Unknown Individual is 1104801869

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104801869
Phone
(419) 385-0566
Address
5122 HEATHERDOWNS BLVD
Deactivation Date
1 November 2023

Doctor Profile

Medical School Name
CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Secondary Phone
4198738280
Graduation Year
1985 (41 years ago)
PAC ID
1658361316
Group Practice PAC ID
5890947121
Professional Enrollment ID
I20040514000423
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 5122, Heatherdowns Boulevard, Toledo, Lucas County, Ohio, 43614, United States

    SUITE 103

    TOLEDO, OH 436142182

    Phone: (419) 385-0566

    Fax: (419) 385-0260

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $32.

Total Amount is formed as General ($32) + Research ($0) + Ownership ($0) = $32.

Last reported payment date: 2023-03-15 • Largest payer in this snapshot: ABBVIE INC. ($32).

Total Amount

$32

General + Research + Ownership

Payments

1

Total payment records

General Amount

$32

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-15

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$32
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 43614)

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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: 5890947121View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1104801869 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Urology Physician. Clinical services aligned with this taxonomy classification.
Where in Ohio is Unknown Individual registered?
Use Toledo, Ohio as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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