Unknown Individual – Family Medicine Physician, NPI 1265614317

Unknown Individual is a healthcare provider. based in Fort collins, Colorado. specializing in Family Medicine Physician. They hold a License No. 46099 (CO). The NPI Number for Unknown Individual is 1265614317

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1265614317
Phone
(970) 377-0734
Address
825 MILAN TERRACE DR
Deactivation Date
22 February 2023

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
9704958800
Graduation Year
1988 (38 years ago)
PAC ID
4981794427
Group Practice PAC ID
7618880709
Professional Enrollment ID
I20071220000174
Data current as of
20 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

  • 825, Milan Terrace Drive, Oakridge Estates, Fort Collins, Larimer County, Colorado, 80525, United States

    FORT COLLINS, CO 805256713

    Phone: (970) 377-0734

    Type: Mailing

  • 2121, East Harmony Road, Fort Collins, Larimer County, Colorado, 80528-9599, United States

    SUITE 310

    FORT COLLINS, CO 805283400

    Phone: (970) 221-3855

    Fax: (970) 212-1238

    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 80525)

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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: 7618880709View full group profile
NameSpecialtyState
H O S P I T A L I S TCO
-CO
-CO
Nurse PractitionerCO
-CO
Mental Health CounselorCO
-WY
Family PracticeCO
Nurse PractitionerCO
Family PracticeCO

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1265614317 — is the standard way to identify this listing.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Fort Collins, Colorado in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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