Unknown Individual – Podiatrist, NPI 1619076429

Unknown Individual is a healthcare provider. based in Burbank, California. specializing in Podiatrist. They hold a License No. E1992 (CA). The NPI Number for Unknown Individual is 1619076429

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619076429
Phone
(818) 848-5583
Address
241 W OLIVE AVE
Deactivation Date
29 April 2023

Doctor Profile

Medical School Name
CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Secondary Phone
8188485583
Graduation Year
1973 (53 years ago)
PAC ID
5890901292
Group Practice PAC ID
2264450683
Professional Enrollment ID
I20110104000880
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

  • 241, West Olive Avenue, Burbank, Los Angeles County, California, 91502, United States

    BURBANK, CA 915021825

    Phone: (818) 848-5583

    Fax: (818) 848-1872

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $1,039.

Total Amount is formed as General ($1,039) + Research ($0) + Ownership ($0) = $1,039.

Last reported payment date: 2023-11-27 • Largest payer in this snapshot: IQ Med LLC ($1,039).

Total Amount

$1,039

General + Research + Ownership

Payments

1

Total payment records

General Amount

$1,039

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-27

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
IQ Med LLC$1,039
View all Open Payments →|Open Payments Risk Radar →

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 91502)

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Provider's Procedures

Unknown Individual performs procedures in Podiatrist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PODIATRYCA11042Removal of skin and tissue first 20 sq cm or less2212
PODIATRYCA11056Removal of 2 to 4 thickened skin growths1816
PODIATRYCA73630X-ray of foot, minimum of 3 views426230

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: 2264450683View full group profile
NameSpecialtyState
P O D I A T R YMI
P O D I A T R YCA
P O D I A T R YCA
P O D I A T R YCA
P O D I A T R YNY
P O D I A T R YPA
P O D I A T R YPA
P O D I A T R YCA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1619076429 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Podiatrist. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Burbank, California in registry-derived data.
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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