Unknown Individual – Gastroenterology Physician, NPI 1174525182

Unknown Individual is a healthcare provider. based in Chattanooga, Tennessee. specializing in Gastroenterology Physician. They hold a License No. 27097 (TN). The NPI Number for Unknown Individual is 1174525182

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174525182
Phone
(423) 267-5677
Address
979 E 3RD ST
Deactivation Date
22 May 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
4232675677
Graduation Year
1982 (44 years ago)
PAC ID
1951583475
Group Practice PAC ID
6305979360
Professional Enrollment ID
I20110304000401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 979, East 3rd Street, Chattanooga, Hamilton County, Tennessee, 37403, United States

    SUITE C0630

    CHATTANOOGA, TN 374032136

    Phone: (423) 267-5677

    Fax: (423) 267-6179

    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)

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 37403)

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Provider's Procedures

Unknown Individual performs procedures in Gastroenterology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GASTROENTEROLOGYTN43235Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope4443
GASTROENTEROLOGYTN45378Diagnostic examination of large bowel using an endoscope1212

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: 6305979360View full group profile
NameSpecialtyState
Nurse PractitionerTN
G A S T R O E N T E R O L O G YTN

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1174525182 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Gastroenterology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Chattanooga?
Public fields place Unknown Individual around Chattanooga, Tennessee. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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