Unknown Individual – Family Medicine Physician, NPI 1609226737

Family Medicine Physician

Unknown Individual is a healthcare provider. based in St george, Utah. specializing in Family Medicine Physician. They hold a License No. 112799561205 (UT). The NPI Number for Unknown Individual is 1609226737

Main info

Organization

Inactive

10 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1609226737

Phone

(435) 656-2995

Address

1664 S DIXIE DR

Deactivation Date

24 July 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3858876277

Graduation Year

2016 (10 years ago)

PAC ID

5890052138

Group Practice PAC ID

1850209420

Professional Enrollment ID

I20190812003025

Data current as of

20 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

1664, South Dixie Drive, St. George, Washington County, Utah, 84770, United States
STE D102
ST GEORGE, UT 847707329
Phone: (435) 656-2995
Fax: (435) 656-3237
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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99222	Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	90	88	$0
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	30	30	$0

View full utilization report →

Insurance plans in this area (ZIP 84770)

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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: 1850209420View full group profile

Name	Specialty	State
MR. SARUNAS SLIESORAITIS (DO, PHARM D)	-	OR
BRETT A CHRISTIAN (M.D.)	Diagnostic Radiology	UT
STEPHEN CRAIG MERRELL (M.D., M.P.H.)	Family Practice	UT
MIKHAIL SHIPOTKO (MD)	H O S P I T A L I S T	UT
RICHARD OTT (M.D.)	O B S T E T R I C S/ G Y N E C O L O G Y	UT
MS. SHARON A KORHEL (APRN)	-	UT
DR. TIMOTHY TRASK (M.D.)	-	UT
JAMES F ORME (MD)	-	UT
JUNE C. STEINVORTH (MD)	Family Practice	UT
RYAN NELSON JONES (M.D.)	-	UT