Unknown Individual – Family Medicine Physician, NPI 1295816684

Unknown Individual is a healthcare provider. based in Big bear lake, California. specializing in Family Medicine Physician. They hold a License No. G058592 (CA). The NPI Number for Unknown Individual is 1295816684

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1295816684
Phone
(909) 866-5808
Address
PO BOX 1567
Deactivation Date
28 December 2022

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Secondary Phone
9098665808
Graduation Year
1978 (48 years ago)
PAC ID
9830233162
Professional Enrollment ID
I20100224000389
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

  • Big Bear Lake Post Office, Pine Knot Avenue, Big Bear Lake, San Bernardino County, California, 92315, United States

    BIG BEAR LAKE, CA 92315

    Phone: (909) 866-5808

    Fax: (909) 855-9502

    Type: Mailing

  • 42002, Fox Farm Road, Big Bear Lake, San Bernardino County, California, 92315, United States

    SUITE 200

    BIG BEAR LAKE, CA 92315

    Phone: (909) 866-5808

    Fax: (909) 866-9502

    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 92315)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINECA82270Stool analysis for blood to screen for colon tumors4040

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1295816684 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Big Bear Lake, California because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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