Unknown Individual – Emergency Medicine Physician, NPI 1053338509

Unknown Individual is a healthcare provider. based in Saint augustine, Florida. specializing in Emergency Medicine Physician. They hold a License No. 23464 (WV). The NPI Number for Unknown Individual is 1053338509

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053338509
Phone
(904) 392-8462
Address
1960 US 1 S
Deactivation Date
10 April 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Secondary Phone
8004243672
Graduation Year
1978 (48 years ago)
PAC ID
3375445208
Group Practice PAC ID
8628153087
Professional Enrollment ID
I20040122000311
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience40
Completeness75
Years active:0State licenses:6Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Saint Johns County Public Library Main Branch, 1960, Ponce de Leon Boulevard, Model Land Historic District, Uptown, West Augustine, Saint Augustine, Saint Johns County, Florida, 32084, United States

    #503

    SAINT AUGUSTINE, FL 320864233

    Phone: (904) 392-8462

    Fax: (904) 794-1416

    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
99285Emergency department visit with high level of medical decision making8886$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only5048$0
99284Emergency department visit with moderate level of medical decision making4342$0
99283Emergency department visit with low level of medical decision making2323$0
99291Critical care, first 30-74 minutes2019$0
View full utilization report →

Insurance plans in this area (ZIP 32086)

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Provider's Procedures

Unknown Individual performs procedures in Emergency Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
EMERGENCY MEDICINEFL93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report250226

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: 8628153087View full group profile
NameSpecialtyState
Emergency MedicineNV
Emergency MedicineFL
Emergency MedicineRI
Emergency MedicineGA
Internal Medicine, Emergency MedicineFL
Emergency MedicineFL
Nurse PractitionerFL
Emergency MedicineFL
Emergency MedicineFL
Emergency MedicineOH

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1053338509.
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 services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Saint Augustine, Florida. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.