Unknown Individual – Obstetrics & Gynecology Physician, NPI 1902881139

Unknown Individual is a healthcare provider. based in Greeley, Colorado. specializing in Obstetrics & Gynecology Physician. They hold a License No. 42859 (CO). The NPI Number for Unknown Individual is 1902881139

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1902881139
Phone
(970) 336-1500
Address
1715 61ST AVE
Deactivation Date
3 March 2022

Doctor Profile

Medical School Name
WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY
Secondary Phone
-
Graduation Year
1987 (39 years ago)
PAC ID
2961478649
Group Practice PAC ID
8022927342
Professional Enrollment ID
I20040903000313
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

  • 1715, 61st Avenue, Greeley, Weld County, Colorado, 80634, United States

    GREELEY, CO 806347989

    Phone: (970) 336-1500

    Fax: (970) 336-1505

    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 80634)

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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: 8022927342View full group profile
NameSpecialtyState
Physician AssistantCO
Radiation OncologyTX
-CO
Hospitalist, General Practice, Family PracticeCO
Cardiovascular Disease (Cardiology)NM
Family PracticeOK
Internal MedicineCO
-IL
H E M A T O L O G Y/ O N C O L O G YTX
Internal MedicinePA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1902881139 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Obstetrics & Gynecology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Greeley, Colorado in the same public data insurers reference.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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