Unknown Individual – Cardiovascular Disease Physician, NPI 1164404745

Unknown Individual is a healthcare provider. based in Miamisburg, Ohio. specializing in Cardiovascular Disease Physician. They hold a License No. 35-03-6591W (OH). The NPI Number for Unknown Individual is 1164404745

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164404745
Phone
(937) 752-2305
Address
1 PRESTIGE PL
Deactivation Date
11 December 2025

Doctor Profile

Medical School Name
NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Secondary Phone
9373129890
Graduation Year
1968 (58 years ago)
PAC ID
4789873480
Group Practice PAC ID
0840104360
Professional Enrollment ID
I20110112000112

Contacts

Secure Messaging
fwenzke205913@direct.ketteringhealth.org
FHIR Endpoint
https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 1, Prestige Plaza Drive, South Dayton, Miamisburg, Montgomery County, Ohio, 45342, United States

    SUITE 550

    MIAMISBURG, OH 453423794

    Phone: (937) 752-2305

    Fax: (937) 522-7513

    Type: Mailing

  • 1380 E STROOP RD

    KETTERING, OH 454294926

    Phone: (937) 293-3486

    Fax: (937) 293-3605

    Type: Mailing

  • 1380, East Stroop Road, Oakdale, Kettering, Montgomery County, Ohio, 45429, United States

    KETTERING, OH 454294926

    Phone: (937) 294-4356

    Fax: (937) 297-2381

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes356166$0
93000Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report305166$0
78452Nuclear medicine studies of heart muscle at rest and with stress and spect137136$0
93018Exercise or drug-induced heart stress test with electrocardiogram (ecg) with review by physician6060$0
93306Ultrasound of heart with color-depicted blood flow, rate, direction and valve function5958$0
View full utilization report →

Insurance plans in this area (ZIP 45342)

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Provider's Procedures

Unknown Individual performs procedures in Cardiovascular Disease Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)OH78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies255254

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: 0840104360View 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 1164404745.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Cardiovascular Disease Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Miamisburg, Ohio for Unknown Individual based on available NPPES addresses.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1164404745. Always confirm identity and privileges with the practice and licensing boards.

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