Unknown Individual – Family Medicine Physician, NPI 1508859653

Unknown Individual is a healthcare provider. based in Berlin, Wisconsin. specializing in Family Medicine Physician. They hold a License No. 21880-020 (WI). The NPI Number for Unknown Individual is 1508859653

Main info

Organization
Inactive
52 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1508859653
Phone
(920) 361-1313
Address
225 MEMORIAL DR
Deactivation Date
7 August 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3146534000
Graduation Year
1974 (52 years ago)
PAC ID
9739156027
Group Practice PAC ID
4587624226
Professional Enrollment ID
I20191003000522
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • ThedaCare Medical Center-Berlin, 225, Memorial Drive, City of Berlin, Green Lake County, Wisconsin, 54923, United States

    BERLIN, WI 549231243

    Phone: (920) 361-1313

    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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
77067Screening mammography142142$0
77063Screening 3d breast mammography138138$0
71046X-ray of chest, 2 views123115$0
71045X-ray of chest, 1 view11295$0
73564X-ray of knee, 4 or more views8669$0
View full utilization report →

Insurance plans in this area (ZIP 54923)

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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: 4587624226View full group profile
NameSpecialtyState
JOHN H NIEMEYER (MD)
-MO
DR. TONI CLARA ROTH (MD)
-MO
Unknown Individual
-MO
DR. LINDA R PROCTOR (MD)
Diagnostic RadiologyMO
DAVID P DIEMER (MD)
-MO
DR. STEVEN L SOLOMON (MD)
-MO
JOHN T ENGELS (MD)
-MO
DR. JEFFREY L SHORE (MD)
-MO

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1508859653 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Berlin, Wisconsin for Unknown Individual; download NPPES for the complete set.
What if Berlin, Wisconsin seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.