Unknown Individual – Internal Medicine Physician, NPI 1992773352

Unknown Individual is a healthcare provider. based in Berkeley, California. specializing in Internal Medicine Physician. They hold a License No. A77458 (CA). The NPI Number for Unknown Individual is 1992773352

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1992773352
Phone
(510) 525-8980
Address
1510 4TH ST
Deactivation Date
22 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4089884888
Graduation Year
1983 (43 years ago)
PAC ID
5890856892
Group Practice PAC ID
7416197496
Professional Enrollment ID
I20081209000793
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

  • 1510, Fourth Street, Ocean View, Berkeley, Alameda County, California, 94710, United States

    SUITE 1

    BERKELEY, CA 947101717

    Phone: (510) 525-8980

    Fax: (510) 525-8982

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 94710)

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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: 7416197496View full group profile
NameSpecialtyState
Internal MedicineCA
Internal MedicineCA
Internal MedicineCA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1992773352 in the public NPI dataset.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Berkeley, California as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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