Unknown Individual – Diagnostic Radiology Physician, NPI 1174597827

Unknown Individual is a healthcare provider. based in Palm springs, California. specializing in Diagnostic Radiology Physician. They hold a License No. G6240 (CA). The NPI Number for Unknown Individual is 1174597827

Main info

Organization
Inactive
67 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174597827
Phone
(760) 323-0620
Address
525 N JUANITA DR
Deactivation Date
7 March 2022

Doctor Profile

Medical School Name
UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Secondary Phone
8167535119
Graduation Year
1959 (67 years ago)
PAC ID
2365340080
Group Practice PAC ID
5395996284
Professional Enrollment ID
I20160420002471
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

  • 525, North Juanita Drive, Palm Springs, Riverside County, California, 92262, United States

    PALM SPRINGS, CA 922626218

    Phone: (760) 323-0620

    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 92262)

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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: 5395996284View full group profile
NameSpecialtyState
Diagnostic RadiologyOK
Diagnostic RadiologyOK
-OK

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1174597827.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Palm Springs, California?
If you are local to Palm Springs, California, Unknown Individual may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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