Unknown Individual – Family Medicine Physician, NPI 1225253933

Unknown Individual is a healthcare provider. based in Covelo, California. specializing in Family Medicine Physician. They hold a License No. A39590 (CA). The NPI Number for Unknown Individual is 1225253933

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1225253933
Phone
(707) 983-6404
Address
PO BOX 247
Deactivation Date
13 November 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5308469000
Graduation Year
1973 (53 years ago)
PAC ID
5991766214
Group Practice PAC ID
6800709049
Professional Enrollment ID
I20151215001443
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 247

    COVELO, CA 954280247

    Phone: (707) 983-6404

    Fax: (707) 983-6184

    Type: Mailing

  • HIGHWAY 162 & BIGGAR LANE

    COVELO, CA 954280247

    Phone: (707) 983-6404

    Fax: (707) 983-6184

    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 95428)

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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: 6800709049View full group profile
NameSpecialtyState
Nurse PractitionerCA
-CA
C H I R O P R A C T I CCA
Cardiovascular Disease (Cardiology)CA
Physician AssistantCA
Internal Medicine, Cardiovascular Disease (Cardiology)IL
Emergency Medicine, Family Practice, Emergency Medicine, Family PracticeWI
-CA
Orthopedic SurgeryWI
Internal MedicineCA

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1225253933.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Family Medicine Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Covelo, California in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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