Unknown Individual – Anatomic Pathology & Clinical Pathology Physician, NPI 1154391043

Anatomic Pathology & Clinical Pathology Physician

Unknown Individual is a healthcare provider. based in Toledo, Ohio. specializing in Anatomic Pathology & Clinical Pathology Physician. They hold a License No. 11852 (SC). The NPI Number for Unknown Individual is 1154391043

Main info

Organization

Inactive

43 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1154391043

Phone

(800) 288-8325

Address

5700 SOUTHWYCK BLVD

Deactivation Date

22 September 2021

Doctor Profile

Medical School Name

MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE

Secondary Phone

8642953492

Graduation Year

1983 (43 years ago)

PAC ID

2961300835

Group Practice PAC ID

9537072897

Professional Enrollment ID

I20031231000032

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

5700, Southwyck Boulevard, Southwyck, Toledo, Lucas County, Ohio, 43614, United States
TOLEDO, OH 436141509
Phone: (800) 288-8325
Fax: (419) 866-5453
Type: Mailing
Columbia, 14375, Northwest Science Park Drive, Marlene Village, Portland, Metro, Washington County, Oregon, 97229, United States
SUITE 200
COLUMBIA, SC 292039344
Phone: (803) 252-1913
Fax: (803) 252-2330
Type: Location

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 43614)

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Provider's Procedures

Unknown Individual performs procedures in Anatomic Pathology & Clinical Pathology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PATHOLOGY	SC	88312	Special stained specimen slides to identify organisms including interpretation and report	25	11

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: 9537072897View full group profile

Name	Specialty	State
DR. DANIEL ALEXANDER ANDERSON (MD)	P A T H O L O G Y	WA
LUMINITA REZEANU (M.D.)	P A T H O L O G Y	OH
DR. PAUL MATTHIAS SCHEELE (MD)	P A T H O L O G Y	SC
CHARLES MICHAEL WOLFF (M.D.)	-	SC
SAMUEL HOUSTON DEMENT (MD)	-	SC
MRS. STEPHANIE ANNE WOLANIN (M.D.)	P A T H O L O G Y	SC
ELIZABETH MOHLER BAILEY (M.D.)	P A T H O L O G Y	SC
JUAN CARLOS ALVAREZ MORENO (MD)	P A T H O L O G Y	TN
DR. ROBERT OSCAR RAINER (MD)	-	SC
JESSE RAY STAFFORD (M.D.)	-	SC

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?

You can confirm Unknown Individual with NPI 1154391043; it appears in the national provider directory.

How do I interpret inactive records for Unknown Individual?

Treat inactive as a signal to verify Unknown Individual through official channels.

What kind of provider is Unknown Individual?

The page reflects Anatomic Pathology & Clinical Pathology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.

Does Unknown Individual practice in Ohio?

You will see Toledo, Ohio on file for Unknown Individual alongside any extra practice locations.

Does Medicare enrollment show here?

Medicare enrollment screens are separate from the basic NPI extract shown here.