Unknown Individual – Pediatric Surgery Physician, NPI 1376653568

Unknown Individual is a healthcare provider. based in Rockford, Illinois. specializing in Pediatric Surgery Physician. They hold a License No. 036049256 (IL). The NPI Number for Unknown Individual is 1376653568

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1376653568
Phone
(815) 971-2000
Address
2350 N ROCKTON AVE
Deactivation Date
22 September 2022
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

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Provider Addresses for Unknown Individual

  • 2350, North Rockton Avenue, Rockford, Winnebago County, Illinois, 61103, United States

    ROCKFORD, IL 611033600

    Phone: (815) 971-2000

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61103)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1376653568.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Pediatric Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Rockford, Illinois may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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