Unknown Individual – Emergency Medicine Physician, NPI 1699724591

Unknown Individual is a healthcare provider. based in Boulder, Colorado. specializing in Emergency Medicine Physician. They hold a License No. 17075 (CO). The NPI Number for Unknown Individual is 1699724591

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1699724591
Phone
(303) 530-4607
Address
7028 INDIAN PEAKS TRAIL
Deactivation Date
22 December 2021

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
7197432421
Graduation Year
1969 (57 years ago)
PAC ID
9739073248
Group Practice PAC ID
0547696254
Professional Enrollment ID
I20040407000091
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

  • 7028, Indian Peaks Trail, Gunbarrel, Boulder County, Colorado, 80301, United States

    BOULDER, CO 80301

    Phone: (303) 530-4607

    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 80301)

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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: 0547696254View full group profile
NameSpecialtyState
-OK

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1699724591.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Boulder, Colorado?
If you are local to Boulder, Colorado, Unknown Individual may be relevant to your search.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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