Unknown Individual – Psychiatry Physician, NPI 1104012228

Unknown Individual is a healthcare provider. based in Anchorage, Alaska. specializing in Psychiatry Physician. They hold a License No. MD7489 (HI). The NPI Number for Unknown Individual is 1104012228

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104012228
Phone
(888) 353-7574
Address
2925 DeBarr Rd
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7329957172
Graduation Year
1983 (43 years ago)
PAC ID
7214152164
Group Practice PAC ID
4082049036
Professional Enrollment ID
I20200121002311
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

Provider Addresses for Unknown Individual

  • 2925 DeBarr Rd

    STE 116

    Anchorage, AK 995082983

    Phone: (888) 353-7574

    Fax: (907) 257-6747

    Type: Location

  • South 16th Street, Phoenix, Maricopa County, Arizona, 85034-5121, United States

    PHOENIX, AZ 85042

    Phone: (602) 434-8457

    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 99508)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4082049036View full group profile
NameSpecialtyState
P S Y C H I A T R YNY
P S Y C H I A T R YNY
P S Y C H I A T R YNY
Mental Health CounselorNY
Mental Health CounselorNY
P S Y C H I A T R YNY
P S Y C H I A T R YNY
Mental Health CounselorNY
P S Y C H I A T R YNY
P S Y C H I A T R YCT

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 1104012228.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Anchorage, Alaska 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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