Unknown Individual – Family Medicine Physician, NPI 1255741302

Unknown Individual is a healthcare provider. based in Hallandale beach, Florida. specializing in Family Medicine Physician. They hold a License No. ME137955 (FL). The NPI Number for Unknown Individual is 1255741302

Main info

Organization
Inactive
12 Years Of Experience
Name
Unknown Individual
NPI
1255741302
Phone
(212) 671-2200
Address
1965 S OCEAN DR APT 15F
Deactivation Date
13 August 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3059745933
Graduation Year
2014 (12 years ago)
PAC ID
8628382363
Group Practice PAC ID
1759503485
Professional Enrollment ID
I20190305002475
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 1965 S OCEAN DR APT 15F

    HALLANDALE BEACH, FL 330095924

    Phone: (212) 671-2200

    Type: Mailing

  • 1400 NE MIAMI GARDENS DR STE 105

    MIAMI, FL 331794843

    Phone: (305) 974-5933

    Type: Location

  • 1400 NE Miami Gardens Dr Ste 105

    Miami, FL 331794843

    Phone: (305) 974-5933

    Type: Location

  • 9635 SW 181st Ter

    Palmetto Bay, FL 331575630

    Phone: (305) 238-8561

    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 33009)

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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: 1759503485View full group profile
NameSpecialtyState
-NC

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1255741302 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Florida?
You will see Hallandale Beach, Florida on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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