Unknown Individual – Diagnostic Radiology Physician, NPI 1104925742

Unknown Individual is a healthcare provider. based in Coral springs, Florida. specializing in Diagnostic Radiology Physician. They hold a License No. ME0027558 (FL). The NPI Number for Unknown Individual is 1104925742

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104925742
Phone
(954) 721-2200
Address
10010 NW 45TH ST
Deactivation Date
15 November 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9547420112
Graduation Year
1973 (53 years ago)
PAC ID
5597755041
Group Practice PAC ID
0648299925
Professional Enrollment ID
I20041118000607
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

  • Northwest 45th Street, The Crossings, Hidden Hammocks Estates, Coral Springs, Broward County, Florida, 33067, United States

    CORAL SPRINGS, FL 330651591

    Phone: (954) 721-2200

    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)

CMS reports 2 Open Payments records for all available years, with a total value of $259.

Total Amount is formed as General ($259) + Research ($0) + Ownership ($0) = $259.

Last reported payment date: 2024-04-25 • Largest payer in this snapshot: HeartFlow, Inc. ($144).

Total Amount

$259

General + Research + Ownership

Payments

2

Total payment records

General Amount

$259

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-04-25

Latest reported date

Top Companies

Largest payers in this snapshot

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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
71045X-ray of chest, 1 view593439$0
70450Ct scan head or brain without contrast9490$0
74018X-ray of abdomen, 1 view6962$0
71046X-ray of chest, 2 views5953$0
93880Ultrasound of both sides of head and neck blood flow4646$0
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Insurance plans in this area (ZIP 33065)

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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 RADIOLOGYFL71010X-ray of chest, 1 view, front19751257
DIAGNOSTIC RADIOLOGYFL73630X-ray of foot, minimum of 3 views1714
DIAGNOSTIC RADIOLOGYFL74177CT scan of abdomen and pelvis with contrast5554
DIAGNOSTIC RADIOLOGYFL77012Radiological supervision and interpretation of CT guidance for needle insertion1818
DIAGNOSTIC RADIOLOGYFL93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers1716

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: 0648299925View full group profile
NameSpecialtyState
Internal MedicineFL
Family PracticeFL

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1104925742 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Coral Springs, Florida; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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