Unknown Individual – Psychiatry Physician, NPI 1720172554

Unknown Individual is a healthcare provider. based in San jose, California. specializing in Psychiatry Physician. They hold a License No. A37138 (CA). The NPI Number for Unknown Individual is 1720172554

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1720172554
Phone
Not provided
Address
751 S BASCOM AVE
Deactivation Date
15 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5106750600
Graduation Year
1981 (45 years ago)
PAC ID
6406828532
Group Practice PAC ID
1052580115
Professional Enrollment ID
I20040810000477
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

  • Santa Clara Valley Medical Center, 751, South Bascom Avenue, Buena Vista, San Jose, Santa Clara County, California, 95128, United States

    SAN JOSE, CA 951282604

    Phone:

    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)

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
99214Established patient office or other outpatient visit, 30-39 minutes43282$0
99215Established patient office or other outpatient visit, 40-54 minutes8239$0
99213Established patient office or other outpatient visit, 20-29 minutes4833$0
G2212Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or1511$0
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Insurance plans in this area (ZIP 95128)

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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: 1052580115View full group profile
NameSpecialtyState
P S Y C H I A T R YCA
P S Y C H I A T R YAL
P S Y C H I A T R YCA
-CA
P S Y C H I A T R YIL
-CA
P S Y C H I A T R YNJ
Nurse PractitionerCA
-CA
N E U R O P S Y C H I A T R YNY

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1720172554 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes San Jose, California for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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