Unknown Individual – General Practice Physician, NPI 1114925880

Unknown Individual is a healthcare provider. based in Streator, Illinois. specializing in General Practice Physician. The NPI Number for Unknown Individual is 1114925880

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114925880
Phone
(815) 672-5500
Address
409 E BRIDGE ST
Deactivation Date
24 November 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

  • First National Bank of Ottawa, 409, East Bridge Street, South Streator, Streator, LaSalle County, Illinois, 61364, United States

    STREATOR, IL 613642915

    Phone: (815) 672-5500

    Fax: (815) 673-5522

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 61364)

Loading plans...

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1114925880.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights General Practice Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Streator, Illinois in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

Similar Providers

ALLEN J RUSSELL (M.D.)

Diagnostic Radiology Physician
6601 COLLEGE BLVD STE 120
NPI: 1184627945

DR. JAMES E. JR. PROBST (D.O.)

Emergency Medicine Physician
2250, North Illinois Avenue, Carbondale, Jackson County, Illinois, 62901, United States
NPI: 1194729517

DR. PRASOP RATTANANONT (M.D)

General Practice Physician
Northwest 2nd Street, Aledo, Mercer County, Illinois, 61231, United States
NPI: 1154326072

Unknown Individual

General Practice Physician
Gibson Area Hospital & Health Services, 1120, North Melvin Street, Gibson City, Ford County, Illinois, 60936, United States
NPI: 1487659074

VENANCIO DECASTRO (M.D.)

General Practice Physician
600, West Lake Cook Road, Buffalo Grove, Wheeling Township, Cook County, Illinois, 60089, United States
NPI: 1205832243

MR. EDDIE LYNN PAULK (D.O.)

Internal Medicine Physician
6810 STATE ROUTE 162 BOX 215
NPI: 1003813601