Unknown Individual – Emergency Medicine Physician, NPI 1891723227

Emergency Medicine Physician

Unknown Individual is a healthcare provider. based in San bernardino, California. specializing in Emergency Medicine Physician. They hold a License No. A51296 (CA). The NPI Number for Unknown Individual is 1891723227

Main info

Organization

Inactive

45 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1891723227

Phone

(909) 335-4188

Address

PO BOX 10069

Deactivation Date

18 November 2022

Doctor Profile

Medical School Name

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

9098621191

Graduation Year

1981 (45 years ago)

PAC ID

9234294513

Group Practice PAC ID

0547164295

Professional Enrollment ID

I20090220000220

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

PO BOX 10069
SAN BERNARDINO, CA 924230069
Phone: (909) 335-4188
Type: Mailing
7000, Boulder Avenue, Molino, Highland, San Bernardino County, California, 92346, United States
HIGHLAND, CA 923463348
Phone: (909) 862-1191
Fax: (909) 796-4158
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 92423)

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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: 0547164295View full group profile

Name	Specialty	State
GLEN R. GAERTE (O.D.)	-	CA
RAYMOND SEDGH (M.D.)	-	CA
EDMUND YUEY KUN KO (M.D.)	U R O L O G Y	CA
DR. THOMAS A. STEINMANN (O.D.)	O P T O M E T R Y	CA
MIGUEL ANGEL MARTINEZ (MD)	-	CA
DR. MARVIN DONALD BRAUER (M.D.)	-	CA
KERRY D ROLD (M.D.)	-	CA
ERINN LEWIS DEGRACIA (FNP)	Nurse Practitioner	CA
SHANTHARAM PAI (M.D.)	-	CA
JONATHAN A E BOLTON (M.D.)	-	CA