Unknown Individual – Family Medicine Physician, NPI 1245219880

Unknown Individual is a healthcare provider. based in St petersburg, Florida. specializing in Family Medicine Physician. They hold a License No. OS3212 (FL). The NPI Number for Unknown Individual is 1245219880

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1245219880
Phone
(727) 393-8715
Address
9545 BAY PINES BLVD
Deactivation Date
23 October 2024

Doctor Profile

Medical School Name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
7273938715
Graduation Year
1971 (55 years ago)
PAC ID
0941492193
Group Practice PAC ID
8123922663
Professional Enrollment ID
I20101007000174
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

  • Tyrone Boulevard North, Saint Petersburg, Pinellas County, Florida, 33709, United States

    ST PETERSBURG, FL 337083754

    Phone: (727) 393-8715

    Fax: (727) 393-8717

    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)

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 33708)

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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: 8123922663View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1245219880 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Florida?
You will see St Petersburg, Florida on file for Unknown Individual alongside any extra practice locations.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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