Unknown Individual – Psychiatry Physician, NPI 1083682900

Unknown Individual is a healthcare provider. based in Derby, Connecticut. specializing in Psychiatry Physician. They hold a License No. 030911 (CT). The NPI Number for Unknown Individual is 1083682900

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083682900
Phone
(203) 732-7550
Address
130 DIVISION ST
Deactivation Date
16 October 2025

Doctor Profile

Medical School Name
UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE
Secondary Phone
8603586760
Graduation Year
1988 (38 years ago)
PAC ID
2668452228
Group Practice PAC ID
5092611731
Professional Enrollment ID
I20040723000318
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

  • Griffin Hospital, 130, Division Street, Derby, New Haven County, Connecticut, 06418-1326, United States

    GRIFFIN HOSPITAL

    DERBY, CT 064181326

    Phone: (203) 732-7550

    Type: Mailing

  • 248, Seymour Avenue, Derby, New Haven County, Connecticut, 06418-1332, United States

    GRIFFIN HOSPITAL

    DERBY, CT 064181332

    Phone: (203) 732-7550

    Fax: (203) 732-1550

    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 06418)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYCT90853Group psychotherapy42528

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: 5092611731View full group profile
NameSpecialtyState
Family Practice, HospitalistCT
-CT
H O S P I T A L I S TDC
H O S P I T A L I S TCT
Nurse PractitionerCT
Family Practice, Geriatric MedicineCT
-CT
H O S P I T A L I S TCT
Physician AssistantCT
Family PracticeCT

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1083682900 when you need to reference Unknown Individual in forms, claims, or directories.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Derby, Connecticut for Unknown Individual based on available NPPES addresses.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1083682900. Always confirm identity and privileges with the practice and licensing boards.

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