Unknown Individual – Dermatology Physician, NPI 1326040965

Unknown Individual is a healthcare provider. based in Mesa, Arizona. specializing in Dermatology Physician. They hold a License No. 1730 (AZ). The NPI Number for Unknown Individual is 1326040965

Main info

Organization
Inactive
52 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1326040965
Phone
(480) 981-2888
Address
130 S 63RD ST
Deactivation Date
1 January 2026

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
4809812888108
Graduation Year
1974 (52 years ago)
PAC ID
4284626425
Group Practice PAC ID
4587656723
Professional Enrollment ID
I20101119000148
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 130, South 63rd Street, Fountain East, Mesa, Maricopa County, Arizona, 85206, United States

    BLDG 3 SUITE 114

    MESA, AZ 852061620

    Phone: (480) 981-2888

    Fax: (480) 654-0599

    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 9 Open Payments records for all available years, with a total value of $191.

Total Amount is formed as General ($191) + Research ($0) + Ownership ($0) = $191.

Last reported payment date: 2024-05-14 • Largest payer in this snapshot: Organogenesis Inc. ($59).

Total Amount

$191

General + Research + Ownership

Payments

9

Total payment records

General Amount

$191

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-14

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 85206)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYAZ11101Biopsy of each additional growth of skin and/or tissue235169
DERMATOLOGYAZ13132Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet4240

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: 4587656723View full group profile
NameSpecialtyState
D E R M A T O L O G YAZ
Nurse PractitionerAZ
D E R M A T O L O G YAZ
D E R M A T O L O G YAZ

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1326040965.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Dermatology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Mesa, Arizona because that is what the record indicates for Unknown Individual.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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