Unknown Individual – Diagnostic Radiology Physician, NPI 1316909997

Unknown Individual is a healthcare provider. based in Crescent city, California. specializing in Diagnostic Radiology Physician. They hold a License No. G62629 (CA). The NPI Number for Unknown Individual is 1316909997

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1316909997
Phone
(707) 464-1989
Address
1225 MARSHALL ST
Deactivation Date
21 August 2024

Doctor Profile

Medical School Name
STANFORD UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2095645000
Graduation Year
1984 (42 years ago)
PAC ID
9436116456
Group Practice PAC ID
2163597899
Professional Enrollment ID
I20041210000972
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

  • 1225, Marshall Street, Crescent City, Del Norte County, California, 95531, United States

    STE 7

    CRESCENT CITY, CA 955312281

    Phone: (707) 464-1989

    Fax: (707) 464-9593

    Type: Mailing

  • 800, East Washington Boulevard, Downtown, Los Angeles, Los Angeles County, California, 90021, United States

    CRESCENT CITY, CA 955318359

    Phone: (707) 464-1989

    Fax: (707) 464-9593

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
A9575Injection, gadoterate meglumine, 0.1 ml4,10024$0
Q9967Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml4,04542$0
71046X-ray of chest, 2 views107101$0
73562X-ray of knee, 3 views10070$0
73030X-ray of shoulder, minimum of 2 views7868$0
View full utilization report →

Insurance plans in this area (ZIP 95531)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PAIN MANAGEMENTCA71250CT scan chest4949
PAIN MANAGEMENTCA73140X-ray of fingers, minimum of 2 views1615
PAIN MANAGEMENTCA73562X-ray of knee, 3 views10285
PAIN MANAGEMENTCA93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers8380

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: 2163597899View full group profile

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1316909997.
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 Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Crescent City, California in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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