Unknown Individual – Gastroenterology Physician, NPI 1154439636

Unknown Individual is a healthcare provider. based in Cleveland, Ohio. specializing in Gastroenterology Physician. They hold a License No. 35-03-2714B (OH). The NPI Number for Unknown Individual is 1154439636

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154439636
Phone
(216) 431-1500
Address
PO BOX 932127
Deactivation Date
8 January 2026

Doctor Profile

Medical School Name
UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AND DENTISTRY
Secondary Phone
2163632730
Graduation Year
1969 (57 years ago)
PAC ID
6103874094
Group Practice PAC ID
1153226444
Professional Enrollment ID
I20050107000045

Contacts

Secure Messaging
directmedicalarts120@cleveland.ipsmso.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Box, Cleveland County, Oklahoma, United States

    CLEVELAND, OH 441930008

    Phone: (216) 431-1500

    Type: Mailing

  • 2475, East 22nd Street, Playhouse Square, Cleveland, Cuyahoga County, Ohio, 44115, United States

    SUITE 120

    CLEVELAND, OH 441153221

    Phone: (216) 431-1500

    Fax: (216) 431-7701

    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 44193)

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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: 1153226444View full group profile

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1154439636.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Gastroenterology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Ohio?
You will see Cleveland, Ohio on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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