Unknown Individual – Family Medicine Physician, NPI 1124014972

Unknown Individual is a healthcare provider. based in Bisbee, Arizona. specializing in Family Medicine Physician. They hold a License No. 073726 (AZ). The NPI Number for Unknown Individual is 1124014972

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124014972
Phone
(520) 432-2042
Address
101 COLE AVE
Deactivation Date
8 February 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5204594604
Graduation Year
2002 (24 years ago)
PAC ID
3678752474
Group Practice PAC ID
8820391436
Professional Enrollment ID
I20110126000256
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

  • Copper Queen Community Hospital, 101, Cole Avenue, Bakerville, Warren, Bisbee, Cochise County, Arizona, 85603, United States

    BISBEE, AZ 856031327

    Phone: (520) 432-2042

    Fax: (520) 432-5082

    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 85603)

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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: 8820391436View full group profile
NameSpecialtyState
Geriatric Medicine, Internal MedicineAZ

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1124014972.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Bisbee, Arizona?
If you are local to Bisbee, Arizona, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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