Unknown Individual – Occupational Medicine Physician, NPI 1861409617

Unknown Individual is a healthcare provider. based in Independence, Missouri. specializing in Occupational Medicine Physician. They hold a License No. R8394 (MO). The NPI Number for Unknown Individual is 1861409617

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1861409617
Phone
(816) 561-2105
Address
17020 E US HIGHWAY 40
Deactivation Date
1 May 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

  • Clay Highway, Bentree, Clay County, West Virginia, 25125, United States

    INDEPENDENCE, MO 640555361

    Phone: (816) 561-2105

    Type: Location

  • 723, South Alco Avenue, Maryville, Polk Township, Nodaway County, Missouri, 64468, United States

    MARYVILLE, MO 644682098

    Phone: (660) 582-7240

    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.

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 64055)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1861409617 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
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 Occupational Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Missouri?
You will see Independence, Missouri on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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