Unknown Individual – Critical Care Medicine (Internal Medicine) Physician, NPI 1164461554

Unknown Individual is a healthcare provider. based in Sacramento, California. specializing in Critical Care Medicine (Internal Medicine) Physician. They hold a License No. A66128 (CA). The NPI Number for Unknown Individual is 1164461554

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164461554
Phone
(916) 679-3513
Address
1300 ETHAN WAY STE 600
Deactivation Date
21 February 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9166793590
Graduation Year
1984 (42 years ago)
PAC ID
7113923996
Group Practice PAC ID
4981506730
Professional Enrollment ID
I20061018000690
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Ethan Way, Sacramento, Sacramento County, California, 95825, United States

    SACRAMENTO, CA 958252296

    Phone: (916) 679-3513

    Fax: (916) 679-3563

    Type: Mailing

  • Medical Plaza Drive, Roseville, Placer County, California, 95661, United States

    ROSEVILLE, CA 95661

    Phone: (916) 679-3590

    Fax: (916) 482-3647

    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.

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

Insurance plans in this area (ZIP 95825)

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Provider's Procedures

Unknown Individual performs procedures in Critical Care Medicine (Internal Medicine) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PULMONARY DISEASECA94060Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration2120

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: 4981506730View full group profile
NameSpecialtyState
Internal Medicine, Infectious DiseaseCA
Hospitalist, Pulmonary Disease, Family Practice, Internal MedicineIN
Nurse PractitionerCA
Pulmonary DiseaseCA
Pulmonary Disease, Critical Care (Intensivists)CA
Neurology, Internal MedicineCA
Pulmonary Disease, Critical Care (Intensivists)CA
Pulmonary Disease, Critical Care (Intensivists)CA
Critical Care (Intensivists), Pulmonary DiseaseCA
Critical Care (Intensivists), Pulmonary DiseaseCA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1164461554 in the public NPI dataset.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Critical Care Medicine (Internal Medicine) Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Sacramento, California may find Unknown Individual in results; validate coverage separately.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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