Unknown Individual – Diagnostic Radiology Physician, NPI 1063500361

Unknown Individual is a healthcare provider. based in Naples, Florida. specializing in Diagnostic Radiology Physician. They hold a License No. ME89133 (FL). The NPI Number for Unknown Individual is 1063500361

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063500361
Phone
(239) 348-4000
Address
6017 PINE RIDGE RD # 237
Deactivation Date
12 June 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Secondary Phone
86621837545002
Graduation Year
1969 (57 years ago)
PAC ID
4880508555
Group Practice PAC ID
2062734858
Professional Enrollment ID
I20060412000507
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

  • 237, Caribbean Road, Pine Ridge Estates, North Naples, Collier County, Florida, 34108, United States

    NAPLES, FL 341193956

    Phone: (239) 348-4000

    Fax: (239) 348-4439

    Type: Mailing

  • Physicians Regional Medical Center - Pine Ridge, 6101, Pine Ridge Road, Naples, Collier County, Florida, 34119, United States

    NAPLES, FL 341193900

    Phone: (239) 348-4000

    Fax: (239) 348-4439

    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.

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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 34119)

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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: 2062734858View full group profile

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1063500361.
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 Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Naples, Florida?
If you are local to Naples, Florida, Unknown Individual may be relevant to your search.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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