Unknown Individual – Pain Medicine (Anesthesiology) Physician, NPI 1154717015

Unknown Individual is a healthcare provider. based in San diego, California. specializing in Pain Medicine (Anesthesiology) Physician. They hold a License No. 13858 (CA). The NPI Number for Unknown Individual is 1154717015

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154717015
Phone
(661) 804-0461
Address
1281 9TH AVE UNIT 3009
Deactivation Date
3 July 2024

Doctor Profile

Medical School Name
COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
Secondary Phone
6197385566
Graduation Year
1990 (36 years ago)
PAC ID
8224340609
Group Practice PAC ID
1557656337
Professional Enrollment ID
I20150629001576
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 1281 9TH AVE UNIT 3009

    SAN DIEGO, CA 921014676

    Phone: (661) 804-0461

    Type: Location

  • 1501 5TH AVE

    STE 100

    SAN DIEGO, CA 921013291

    Phone: (661) 809-6528

    Type: Mailing

  • 1281 9TH AVE UNIT 3801

    SAN DIEGO, CA 921014680

    Phone: (661) 804-0461

    Type: Location

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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99310Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes583279$0
99306Initial nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes334321$0
G0317Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualifi253250$0
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes11381$0
99349Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes7535$0
View full utilization report →

Insurance plans in this area (ZIP 92101)

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Provider's Procedures

Unknown Individual performs procedures in Pain Medicine (Anesthesiology) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ANESTHESIOLOGYCA20610Aspiration and/or injection of large joint or joint capsule2617

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: 1557656337View full group profile
NameSpecialtyState
-CA
-CA
Internal Medicine, Pediatric MedicineCA
Nurse PractitionerCA
Nurse PractitionerCA
Physician AssistantCA
General PracticeCA
Nurse PractitionerCA
Nurse PractitionerCA
Nurse PractitionerCA

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1154717015 is assigned to Unknown Individual under the national enumeration system.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What kind of provider is Unknown Individual?
The page reflects Pain Medicine (Anesthesiology) Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display San Diego, California 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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