Unknown Individual – Physician Assistant, NPI 1235173907

Unknown Individual is a healthcare provider. based in Baldwin, Wisconsin. specializing in Physician Assistant. They hold a License No. 39 (WI). The NPI Number for Unknown Individual is 1235173907

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1235173907
Phone
(715) 684-1111
Address
1100 Bergslien St
Deactivation Date
28 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1975 (51 years ago)
PAC ID
7911039706
Group Practice PAC ID
7911800586
Professional Enrollment ID
I20100714000267
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

Provider Addresses for Unknown Individual

  • 1100 Bergslien St

    Baldwin, WI 540022600

    Phone: (715) 684-1111

    Fax: (715) 684-1119

    Type: Location

  • Bergslien Street, Baldwin, Saint Croix County, Wisconsin, 54002, United States

    BALDWIN, WI 540022600

    Phone: (715) 684-1111

    Fax: (715) 684-1119

    Type: Mailing

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 54002)

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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: 7911800586View full group profile
NameSpecialtyState
Physician AssistantCO
Certified Registered Nurse Anesthetist (Crna)OK
-WI
Nurse PractitionerMN
-WI
Hematology, Medical Oncology, Internal Medicine, Medical OncologyMN
O B S T E T R I C S/ G Y N E C O L O G YMN
Hospice/Palliative Care, Family PracticeMN
Internal Medicine, Cardiovascular Disease (Cardiology)MN
Nurse PractitionerWI

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1235173907 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Wisconsin?
You will see Baldwin, Wisconsin on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1235173907. Always confirm identity and privileges with the practice and licensing boards.

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