Unknown Individual – Diagnostic Radiology Physician, NPI 1790781748

Unknown Individual is a healthcare provider. based in Farmington, Connecticut. specializing in Diagnostic Radiology Physician. They hold a License No. 038010 (CT). The NPI Number for Unknown Individual is 1790781748

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790781748
Phone
(860) 679-7503
Address
263 FARMINGTON AVE
Deactivation Date
28 August 2024

Doctor Profile

Medical School Name
DREXEL UNIVERSITY COLLEGE OF MEDICINE
Secondary Phone
8606797503
Graduation Year
1994 (32 years ago)
PAC ID
9830215342
Group Practice PAC ID
3678472016
Professional Enrollment ID
I20100921001526

Contacts

Secure Messaging
mkane10817@direct.med.uchc.edu
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • University of Connecticut Health Center, 263, Farmington Avenue, Farmington, Hartford County, Connecticut, 06030, United States

    PROVIDER ENROLLMENT

    FARMINGTON, CT 060302212

    Phone: (860) 679-7503

    Fax: (860) 679-1610

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
71045X-ray of chest, 1 view163131$0
76705Limited ultrasound scan of abdomen132129$0
76536Ultrasound scan of head and neck soft tissue105102$0
76770Complete ultrasound scan behind abdominal cavity8584$0
71046X-ray of chest, 2 views8077$0
View full utilization report →

Insurance plans in this area (ZIP 06030)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYCT71010X-ray of chest, 1 view, front392288

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: 3678472016View full group profile
NameSpecialtyState
N E U R O S U R G E R YNY
E N D O C R I N O L O G YVA
Orthopedic SurgeryCT
Orthopedic SurgeryCT
Endocrinology, Internal MedicineCT
Critical Care (Intensivists)CT
Hospitalist, Internal MedicineCT
Gynecological OncologyNY
Physician AssistantCT
Hand Surgery, Orthopedic SurgeryCT

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 1790781748 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.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Farmington, Connecticut in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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