Unknown Individual – Surgery Physician, NPI 1962509760

Unknown Individual is a healthcare provider. based in St louis, Missouri. specializing in Surgery Physician. They hold a License No. AL3961237 (MO). The NPI Number for Unknown Individual is 1962509760

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1962509760
Phone
(314) 275-9770
Address
1040 N MASON RD
Deactivation Date
9 May 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

  • 1040, Mason Road, Fernridge, Creve Coeur, Saint Louis County, Missouri, 63141, United States

    #214

    ST LOUIS, MO 63141

    Phone: (314) 275-9770

    Fax: (314) 275-2632

    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 63141)

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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 1962509760.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Surgery Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to St Louis, Missouri in the data we show; additional addresses may exist on the full record.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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