Unknown Individual – Diagnostic Radiology Physician, NPI 1154304053

Unknown Individual is a healthcare provider. based in Coral gables, Florida. specializing in Diagnostic Radiology Physician. They hold a License No. 21848 (FL). The NPI Number for Unknown Individual is 1154304053

Main info

Organization
Inactive
63 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1154304053
Phone
(305) 446-4681
Address
2555 PONCE DE LEON BLVD
Deactivation Date
25 September 2025

Doctor Profile

Medical School Name
STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER
Secondary Phone
7862438000
Graduation Year
1963 (63 years ago)
PAC ID
0941104806
Group Practice PAC ID
5799689659
Professional Enrollment ID
I20040528000117
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

  • 2555, Ponce de Leon Boulevard, Coral Gables, Miami-Dade County, Florida, 33134, United States

    4TH FLOOR

    CORAL GABLES, FL 33134

    Phone: (305) 446-4681

    Type: Mailing

  • Baptist Hospital of Miami, 8900, Southwest 88th Street, Kendall, Miami-Dade County, Florida, 33176, United States

    MIAMI, FL 33176

    Phone: (786) 596-1960

    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.

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.

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

Insurance plans in this area (ZIP 33134)

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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, front677616
DIAGNOSTIC RADIOLOGYFL71250CT scan chest138137
DIAGNOSTIC RADIOLOGYFL73562X-ray of knee, 3 views2320
DIAGNOSTIC RADIOLOGYFL73630X-ray of foot, minimum of 3 views2726
DIAGNOSTIC RADIOLOGYFL74177CT scan of abdomen and pelvis with contrast8684

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: 5799689659View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1154304053 on file in the registry.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Coral Gables?
Public fields place Unknown Individual around Coral Gables, Florida. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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Unknown Individual

Diagnostic Radiology Physician
2555, Ponce de Leon Boulevard, Coral Gables, Miami-Dade County, Florida, 33134, United States
NPI: 1265414320

Unknown Individual

Diagnostic Radiology Physician
2555, Ponce de Leon Boulevard, Coral Gables, Miami-Dade County, Florida, 33134, United States
NPI: 1992787063