Unknown Individual – Physician Assistant, NPI 1255393088

Unknown Individual is a healthcare provider. based in Glenwood springs, Colorado. specializing in Physician Assistant. They hold a License No. 1021 (CO). The NPI Number for Unknown Individual is 1255393088

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255393088
Phone
(970) 384-6770
Address
1906 BLAKE AVE
Deactivation Date
11 September 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9704761100
Graduation Year
1997 (29 years ago)
PAC ID
9234314436
Group Practice PAC ID
7719876226
Professional Enrollment ID
I20110504000118
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

Provider Addresses for Unknown Individual

  • 1906 BLAKE AVE

    GLENWOOD SPRINGS, CO 816014227

    Phone: (970) 384-6770

    Fax: (970) 384-6765

    Type: Mailing

  • 660, Golden Ridge Road, Golden, Jefferson County, Colorado, 80401, United States

    SUITE 250

    GOLDEN, CO 804019541

    Phone: (303) 233-1223

    Fax: (303) 233-8755

    Type: Mailing

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 minutes7563$0
72110X-ray of lower and sacral spine, minimum of 4 views4746$0
99213Established patient office or other outpatient visit, 20-29 minutes4137$0
99204New patient office or other outpatient visit, 45-59 minutes3434$0
72100X-ray of lower and sacral spine, 2-3 views2020$0
View full utilization report →

Insurance plans in this area (ZIP 81601)

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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: 7719876226View full group profile
NameSpecialtyState
Physician AssistantPA
Orthopedic SurgeryCO
Physician AssistantCO
Orthopedic SurgeryFL
Physician AssistantCO
Orthopedic SurgeryPA
Physician AssistantNY
Physician AssistantCO
Physician AssistantCO
-CO

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1255393088.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Physician Assistant for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Glenwood Springs, Colorado because that is what the record indicates for Unknown Individual.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1255393088. Always confirm identity and privileges with the practice and licensing boards.

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