Unknown Individual – Family Medicine Physician, NPI 1619979424

Unknown Individual is a healthcare provider. based in Edwards, Colorado. specializing in Family Medicine Physician. They hold a License No. 31510 (CO). The NPI Number for Unknown Individual is 1619979424

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619979424
Phone
(970) 926-6340
Address
PO BOX 1749
Deactivation Date
26 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9709266340
Graduation Year
1988 (38 years ago)
PAC ID
5395779284
Group Practice PAC ID
5496087181
Professional Enrollment ID
I20050920001239
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 1749

    EDWARDS, CO 816321749

    Phone: (970) 926-6340

    Fax: (970) 926-6348

    Type: Mailing

  • Eagle Healthcare Center, 377, Sylvan Lake Road, Eagle, Eagle County, Colorado, 81631, United States

    SUITE 210

    EAGLE, CO 81631

    Phone: (970) 926-6340

    Fax: (970) 926-6348

    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 81632)

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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: 5496087181View full group profile
NameSpecialtyState
-CO
Family Practice, Emergency MedicineCO
-CO
Nurse PractitionerCO
Nurse PractitionerCO
Physician AssistantWI
-CO
Emergency Medicine, Preventive MedicineCO
Registered Dietitian Or Nutrition ProfessionalCO
-CO

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1619979424.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
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.
Does Unknown Individual list a practice location?
Patients near Edwards, Colorado may find Unknown Individual in results; validate coverage separately.
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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