Unknown Individual – Psychiatry Physician, NPI 1528091030

Unknown Individual is a healthcare provider. based in Appleton, Wisconsin. specializing in Psychiatry Physician. They hold a License No. 01036452A (IN). The NPI Number for Unknown Individual is 1528091030

Main info

Organization
Inactive
50 Years Of Experience
Name
Unknown Individual
NPI
1528091030
Phone
(920) 560-4525
Address
711 N LYNNDALE DR STE 1A
Deactivation Date
26 June 2024

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF OHIO
Secondary Phone
9205607082
Graduation Year
1976 (50 years ago)
PAC ID
7810890233
Group Practice PAC ID
5496068405
Professional Enrollment ID
I20040131000167
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 711 N LYNNDALE DR STE 1A

    APPLETON, WI 549143078

    Phone: (920) 560-4525

    Fax: (920) 560-6618

    Type: Mailing

  • 1611, South Madison Street, Appleton, Outagamie County, Wisconsin, 54915, United States

    APPLETON, WI 549151844

    Phone: (920) 730-5470

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 50 Open Payments records for all available years, with a total value of $930.

Total Amount is formed as General ($930) + Research ($0) + Ownership ($0) = $930.

Last reported payment date: 2024-07-09 • Largest payer in this snapshot: Otsuka America Pharmaceutical, Inc. ($125).

Total Amount

$930

General + Research + Ownership

Payments

50

Total payment records

General Amount

$930

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-07-09

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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
90833Psychotherapy with evaluation and management visit, 30 minutes40377$0
99213Established patient office or other outpatient visit, 20-29 minutes28665$0
99214Established patient office or other outpatient visit, 30-39 minutes15449$0
View full utilization report →

Insurance plans in this area (ZIP 54914)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYWI90792Psychiatric diagnostic evaluation with medical services3636

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: 5496068405View full group profile

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1528091030 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.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Wisconsin?
You will see Appleton, Wisconsin on file for Unknown Individual alongside any extra practice locations.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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