Unknown Individual – Otolaryngology Physician, NPI 1124007828

Unknown Individual is a healthcare provider. based in Scottsdale, Arizona. specializing in Otolaryngology Physician. They hold a License No. 28803 (AZ). The NPI Number for Unknown Individual is 1124007828

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124007828
Phone
(480) 614-0499
Address
9097 E DESERT COVE AVE
Deactivation Date
27 September 2023

Doctor Profile

Medical School Name
SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4806841080
Graduation Year
1996 (30 years ago)
PAC ID
9436147360
Group Practice PAC ID
8729149711
Professional Enrollment ID
I20040430001300
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

  • 9097, East Desert Cove Avenue, Scottsdale, Maricopa County, Arizona, 85260, United States

    # 250

    SCOTTSDALE, AZ 852606279

    Phone: (480) 614-0499

    Fax: (480) 614-4344

    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)

CMS reports 3 Open Payments records for all available years, with a total value of $69.

Total Amount is formed as General ($69) + Research ($0) + Ownership ($0) = $69.

Last reported payment date: 2023-03-27 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($25).

Total Amount

$69

General + Research + Ownership

Payments

3

Total payment records

General Amount

$69

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-27

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes2926$0
View full utilization report →

Insurance plans in this area (ZIP 85260)

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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: 8729149711View full group profile
NameSpecialtyState
O T O L A R Y N G O L O G YAZ
Qualified AudiologistAZ
Physician AssistantAZ
O T O L A R Y N G O L O G YSC
O T O L A R Y N G O L O G YAZ
Qualified AudiologistAZ
O T O L A R Y N G O L O G YAZ
-AZ
A L L E R G Y/ I M M U N O L O G YAZ
O T O L A R Y N G O L O G YAZ

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1124007828 is assigned to Unknown Individual under the national enumeration system.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Otolaryngology Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Scottsdale, Arizona for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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