Unknown Individual – Surgery Physician, NPI 1699871228

Surgery Physician

Unknown Individual is a healthcare provider. based in Englewood, Colorado. specializing in Surgery Physician. They hold a License No. 36602 (CO). The NPI Number for Unknown Individual is 1699871228

Main info

Organization

Inactive

44 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1699871228

Phone

(303) 957-1310

Address

3333 S BANNOCK ST

Deactivation Date

7 February 2024

Doctor Profile

Medical School Name

UNIVERSITY OF UTAH SCHOOL OF MEDICINE

Secondary Phone

Graduation Year

1982 (44 years ago)

PAC ID

3678471562

Group Practice PAC ID

9032002985

Professional Enrollment ID

I20110119001011

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

Wells Fargo, 3333, South Bannock Street, Englewood, Arapahoe County, Colorado, 80113-1525, United States
SUITE 350
ENGLEWOOD, CO 801102432
Phone: (303) 957-1310
Fax: (303) 761-4252
Type: Mailing
South Broadway, Littleton, Arapahoe County, Colorado, 80122, United States
SUITE 310
LITTLETON, CO 801222632
Phone: (303) 798-0916
Fax: (303) 798-0737
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 80110)

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Provider's Procedures

Unknown Individual performs procedures in Surgery Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
GENERAL SURGERY	CO	19301	Partial removal of breast	17	16
GENERAL SURGERY	CO	38900	Lymph node imaging during surgery	15	14

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: 9032002985View full group profile

Name	Specialty	State
LAURA HAFERTEPEN (DO)	General Surgery	CO
ANDRE L REED (MD)	O T O L A R Y N G O L O G Y	CO
WALTER B VERNON (MD)	-	CO
DOUGLAS D BENSON (MD)	General Surgery	CO
SUSAN A SGAMBATI (MD)	-	CO
THOMAS G HEFFRON (MD)	General Surgery, Surgical Oncology	CO
DR. RANDY TAYLOR (M.D.,PH.D)	O T O L A R Y N G O L O G Y	CO
ALEXANDRA E ROGERS (MD)	U R O L O G Y	CA
SAVANNAH KRAMER SHANNON (PA)	Physician Assistant	GA
JORDAN TROKA (PA-C)	Physician Assistant	CO