Unknown Individual – Family Medicine Physician, NPI 1174519151

Family Medicine Physician

Unknown Individual is a healthcare provider. based in St george, Utah. specializing in Family Medicine Physician. They hold a License No. 7359423-1205 (UT). The NPI Number for Unknown Individual is 1174519151

Main info

Organization

Inactive

53 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1174519151

Phone

(435) 628-8944

Address

616 S RIVER RD STE 200

Deactivation Date

17 April 2025

Doctor Profile

Medical School Name

UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE

Secondary Phone

4356563481

Graduation Year

1973 (53 years ago)

PAC ID

0941281844

Group Practice PAC ID

4688801764

Professional Enrollment ID

I20120906000869

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

South River Road, Kingstown, Saint George, VC0100, Saint Vincent and the Grenadines
ST GEORGE, UT 847902105
Phone: (435) 628-8944
Fax: (435) 635-4506
Type: Mailing
Bonrue Bakery (formerly Farmstead), 11, South Main Street, Hurricane, Washington County, Utah, 84737, United States
HURRICANE, UT 847371949
Phone: (435) 635-9444
Fax: (435) 635-8148
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 84790)

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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: 4688801764View full group profile

Name	Specialty	State
DR. DANNY K WORWOOD (MD)	-	UT

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1174519151 — is the standard way to identify this listing.

Is Unknown Individual excluded from programs when inactive?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is St George, Utah in our summary view.

Why does Unknown Individual have multiple addresses?

2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.