Unknown Individual – Diagnostic Radiology Physician, NPI 1194773143

Diagnostic Radiology Physician

Unknown Individual is a healthcare provider. based in Simi valley, California. specializing in Diagnostic Radiology Physician. They hold a License No. G24860 (CA). The NPI Number for Unknown Individual is 1194773143

Main info

Organization

Inactive

54 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1194773143

Phone

(805) 522-5940

Address

PO BOX 190

Deactivation Date

5 July 2023

Doctor Profile

Medical School Name

GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

8188853598

Graduation Year

1972 (54 years ago)

PAC ID

9537063458

Group Practice PAC ID

7315841756

Professional Enrollment ID

I20031124000830

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

Provider Addresses for Unknown Individual

PO BOX 190
SIMI VALLEY, CA 930620190
Phone: (805) 522-5940
Fax: (805) 522-6401
Type: Mailing
5925 SAN VINCENTE BLVD
LOS ANGELES, CA 90024
Phone: (310) 932-5301
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
71045	X-ray of chest, 1 view	682	464	$0
77080	Dxa bone density measurement of hip, pelvis, spine	293	293	$0
70450	Ct scan head or brain without contrast	94	90	$0
71046	X-ray of chest, 2 views	90	86	$0
74177	Ct scan of abdomen and pelvis with contrast	65	63	$0

View full utilization report →

Insurance plans in this area (ZIP 93062)

Loading plans...

Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
INTERVENTIONAL RADIOLOGY	CA	71010	X-ray of chest, 1 view, front	777	488
INTERVENTIONAL RADIOLOGY	CA	71250	CT scan chest	20	20
INTERVENTIONAL RADIOLOGY	CA	73630	X-ray of foot, minimum of 3 views	22	21
INTERVENTIONAL RADIOLOGY	CA	77012	Radiological supervision and interpretation of CT guidance for needle insertion	13	13
INTERVENTIONAL RADIOLOGY	CA	78452	Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	74	74

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: 7315841756View full group profile

Name	Specialty	State
DR. DAVID JAMES SPOUGE (MD)	Diagnostic Radiology	BC
EDWARD S OH (M.D.)	Diagnostic Radiology	AZ
RAJESH ANANT BHAVSAR (M.D.)	Diagnostic Radiology	AR
DR. JOHN EDWARD STEWART (MD, PHD)	Nuclear Medicine, Diagnostic Radiology	NC
DR. JOHN TD VU (MD)	Diagnostic Radiology	MO
DR. JOHN MCMAHAN (M.D.)	-	CA
KELLIE D. CURTIS (MD)	Diagnostic Radiology	CA
DR. BRUCE MATTHEWS (M.D.)	-	CA
VARTAN MASIHI VARTANIANS (M.D.)	Diagnostic Radiology	CA
Unknown Individual	-	MN