Unknown Individual – Medical Physician Assistant, NPI 1003876012

Unknown Individual is a healthcare provider. based in Saint cloud, Minnesota. specializing in Medical Physician Assistant. They hold a License No. 9169 (MN). The NPI Number for Unknown Individual is 1003876012

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1003876012
Phone
(320) 255-6480
Address
4801 VETERANS DR
Deactivation Date
4 September 2024
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

  • St. Cloud VA Health Care System, 4801, Veterans Drive, St. Cloud, Stearns County, Minnesota, 56303, United States

    SAINT CLOUD, MN 563032015

    Phone: (320) 255-6480

    Type: Location

  • 416, 12th Street North, Sartell, Stearns County, Minnesota, 56377, United States

    SARTELL, MN 563771407

    Phone:

    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.

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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.

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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 56303)

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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 1003876012.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Medical Physician Assistant. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Saint Cloud, Minnesota; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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