Unknown Individual – Psychiatry Physician, NPI 1366466476

Unknown Individual is a healthcare provider. based in Jacksonville, Florida. specializing in Psychiatry Physician. They hold a License No. ME80186 (FL). The NPI Number for Unknown Individual is 1366466476

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366466476
Phone
(844) 808-9096
Address
3636 UNIVERSITY BLVD S STE B2
Deactivation Date
18 September 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1984 (42 years ago)
PAC ID
6103816699
Professional Enrollment ID
I20040518000602
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

  • University Boulevard South, Englewood, Jacksonville, Duval County, Florida, 32216, United States

    JACKSONVILLE, FL 322164223

    Phone: (844) 808-9096

    Fax: (904) 638-8752

    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)

CMS reports 5 Open Payments records for all available years, with a total value of $292.

Total Amount is formed as General ($292) + Research ($0) + Ownership ($0) = $292.

Last reported payment date: 2023-08-16 • Largest payer in this snapshot: Teva Pharmaceuticals USA, Inc. ($231).

Total Amount

$292

General + Research + Ownership

Payments

5

Total payment records

General Amount

$292

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-08-16

Latest reported date

Top Companies

Largest payers in this snapshot

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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
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes12949$0
99214Established patient office or other outpatient visit, 30-39 minutes11055$0
90837Psychotherapy, 1 hour10731$0
90833Psychotherapy with evaluation and management visit, 30 minutes9144$0
99238Hospital discharge day management, 30 minutes or less6849$0
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Insurance plans in this area (ZIP 32216)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1366466476 — the number used across U.S. healthcare to identify this provider.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Jacksonville, Florida.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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