Unknown Individual – Psychiatry Physician, NPI 1063778835

Unknown Individual is a healthcare provider. based in Jacksonville, Florida. specializing in Psychiatry Physician. They hold a License No. ME123010 (FL). The NPI Number for Unknown Individual is 1063778835

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063778835
Phone
(904) 719-9220
Address
3948 Sunbeam Rd
Deactivation Date
13 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2005 (21 years ago)
PAC ID
9830404359
Professional Enrollment ID
I20150812009081
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 3948 Sunbeam Rd

    Suite # 2

    Jacksonville, FL 322578852

    Phone: (904) 719-9220

    Fax: (904) 719-9221

    Type: Location

  • 3948 SUNBEAM RD

    SUITE # 2

    JACKSONVILLE, FL 322578852

    Phone: (904) 719-9220

    Fax: (904) 719-9221

    Type: Mailing

  • 2950 HALCYON LN STE 705

    JACKSONVILLE, FL 322236692

    Phone: (904) 719-9220

    Fax: (904) 719-9221

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $14.

Total Amount is formed as General ($14) + Research ($0) + Ownership ($0) = $14.

Last reported payment date: 2023-01-03 • Largest payer in this snapshot: ABBVIE INC. ($14).

Total Amount

$14

General + Research + Ownership

Payments

1

Total payment records

General Amount

$14

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-01-03

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$14
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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32257)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1063778835 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Jacksonville, Florida in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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