Unknown Individual – Internal Medicine Physician, NPI 1003887001

Unknown Individual is a healthcare provider. based in Gales ferry, Connecticut. specializing in Internal Medicine Physician. They hold a License No. 000426 (CT). The NPI Number for Unknown Individual is 1003887001

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003887001
Phone
(860) 464-7274
Address
PO BOX 355
Deactivation Date
10 July 2025

Doctor Profile

Medical School Name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
8604647274
Graduation Year
1988 (38 years ago)
PAC ID
8224170600
Group Practice PAC ID
3971645359
Professional Enrollment ID
I20100902000055
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

Loading map...

Provider Addresses for Unknown Individual

  • PO BOX 355

    GALES FERRY, CT 063350355

    Phone: (860) 464-7274

    Fax: (860) 464-7404

    Type: Mailing

  • Route 12, Allyn Point, Gales Ferry, Ledyard, New London County, Connecticut, 06335, United States

    SUITE 1

    GALES FERRY, CT 063351800

    Phone: (860) 464-7274

    Fax: (860) 464-7404

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

CMS reports 8 Open Payments records for all available years, with a total value of $179.

Total Amount is formed as General ($179) + Research ($0) + Ownership ($0) = $179.

Last reported payment date: 2023-09-19 • Largest payer in this snapshot: GlaxoSmithKline, LLC. ($96).

Total Amount

$179

General + Research + Ownership

Payments

8

Total payment records

General Amount

$179

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-19

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes134121$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit3535$0
81002Urinalysis, manual test3333$0
93000Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report3333$0
82962Blood glucose (sugar) test performed by hand-held instrument3332$0
View full utilization report →

Insurance plans in this area (ZIP 06335)

Loading plans...

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: 3971645359View full group profile

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1003887001.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Gales Ferry, Connecticut in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

Similar Providers

KATHLEEN MARY OCONNOR (A.P.R.N.)

Acute Care Nurse Practitioner
Church Street, Amston, Hebron, Tolland County, Connecticut, 06231, United States
NPI: 1457351017

DR. JOHN JOSEPH HENNESSEY (M.D.)

Internal Medicine Physician
Route 12, Allyn Point, Gales Ferry, Ledyard, New London County, Connecticut, 06335, United States
NPI: 1215916564

DR. SANFORD ALAN GREENHOUSE (M.D.)

Internal Medicine Physician
PO BOX 355
NPI: 1669451894

Unknown Individual

Internal Medicine Physician
PO BOX 355
NPI: 1538149984

GALES FERRY MEDICAL GROUP LLC

Internal Medicine Physician
PO BOX 335
NPI: 1194859058