Unknown Individual – Family Medicine Physician, NPI 1861460628

Unknown Individual is a healthcare provider. based in Saint joseph, Missouri. specializing in Family Medicine Physician. They hold a License No. 108811 (MO). The NPI Number for Unknown Individual is 1861460628

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1861460628
Phone
(816) 232-6818
Address
2303 VILLAGE DR
Deactivation Date
16 December 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

  • 2303, Village Drive, Eastgate, St. Joseph, Buchanan County, Missouri, 64506, United States

    SAINT JOSEPH, MO 645064954

    Phone: (816) 232-6818

    Fax: (816) 232-6823

    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 64506)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1861460628 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Family Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Saint Joseph, Missouri as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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