Unknown Individual – Emergency Medicine Physician, NPI 1356579593

Unknown Individual is a healthcare provider. based in Daytona beach, Florida. specializing in Emergency Medicine Physician. They hold a License No. ME125905 (FL). The NPI Number for Unknown Individual is 1356579593

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356579593
Phone
Not provided
Address
PO BOX 12010
Deactivation Date
24 May 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7723354000
Graduation Year
2009 (17 years ago)
PAC ID
2466616958
Group Practice PAC ID
0648431650
Professional Enrollment ID
I20160215002815
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • PO BOX 12010

    DAYTONA BEACH, FL 321202010

    Phone:

    Type: Mailing

  • Lakeside Medical Center, 39200, Hooker Highway, Belle Glade, Palm Beach County, Florida, 33430, United States

    BELLE GLADE, FL 334305368

    Phone: (561) 996-6571

    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 32120)

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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: 0648431650View full group profile
NameSpecialtyState
DR. SARAH MAE FOWLES (D.O.)
-FL
DR. SYLVIE ANNE RIMMER (M.D.)
-FL
ALEXANDRA SNYDER
-FL
STEVEN WAYNE JR. SUGGS (M.D.)
-NC
JEANETTE ANN ROBERTS (D.O.)
-CO
KRISTEN HANRAHAN (DO)
-FL
DR. PATRICK EDWARD DAVISON (D.O.)
-FL
DR. OLIVER MORRIS (D.O.)
-FL
YOLANDA GONZALEZ (MD)
-LA

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1356579593 as the unique 10-digit identifier.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Daytona Beach?
Unknown Individual currently maps to Daytona Beach, Florida in this extract.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.