Unknown Individual – Psychiatry Physician, NPI 1215039599

Unknown Individual is a healthcare provider. based in Miami, Florida. specializing in PSYCHIATRY, NEUROPSYCHIATRY. They hold a License No. ME 45692 (FL). The NPI Number for Unknown Individual is 1215039599

Main info

Organization
Inactive
60 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215039599
Phone
(305) 301-3143
Address
12315 SW 64 AVENUE
Deactivation Date
9 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3055587400
Graduation Year
1966 (60 years ago)
PAC ID
7113175944
Group Practice PAC ID
8123284759
Professional Enrollment ID
I20120919000544
Address ID
FL330142435MI6175XSTXX402
Telehealth
Yes
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

1,953 PSYCHIATRY in FL

Provider Addresses for Unknown Individual

  • 12315 SW 64 AVENUE

    MIAMI, FL 33156

    Phone: (305) 301-3143

    Fax: (305) 558-6134

    Type: Mailing

  • 6175 NW 153 ST

    #404

    MIAMI LAKES, FL 33014

    Phone: (305) 558-7400

    Fax: (305) 558-6134

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 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: 2024-10-03 • Largest payer in this snapshot: Balt USA, LLC ($259).

Total Amount

$259

General + Research + Ownership

Payments

3

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

2024-10-03

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Balt USA, LLC$259
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
90833Psychotherapy with evaluation and management visit, 30 minutes16647$0
99212Established patient office or other outpatient visit, 10-19 minutes12638$0
99213Established patient office or other outpatient visit, 20-29 minutes4121$0
View full utilization report →

Insurance plans in this area (ZIP 33156)

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Provider's Procedures

Unknown Individual performs procedures in PSYCHIATRY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYFL90833Psychotherapy, 30 minutes with patient and/or family member17959

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: 8123284759View full group profile
NameSpecialtyState
Clinical Social WorkerFL
Clinical PsychologistFL

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1215039599.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Psychiatry Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Miami, Florida as a primary anchor for Unknown Individual unless the record lists multiple sites.
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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