Unknown Individual – Family Medicine Physician, NPI 1366496317

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Bradenton, Florida. specializing in Family Medicine Physician. They hold a License No. ME18247 (FL). The NPI Number for Unknown Individual is 1366496317

Main info

Organization

Inactive

56 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1366496317

Phone

(941) 684-1654

Address

4815 18TH AVE W

Deactivation Date

13 December 2022

Doctor Profile

Medical School Name

UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE

Secondary Phone

Graduation Year

1970 (56 years ago)

PAC ID

7911927066

Professional Enrollment ID

I20051203000041

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

4815, 18th Avenue West, Bradenton, Manatee County, Florida, 34209, United States
BRADENTON, FL 34209
Phone: (941) 684-1654
Fax: (941) 798-9184
Type: Mailing
410, 43rd Street West, Bradenton, Manatee County, Florida, 34209, United States
SUITE I
BRADENTON, FL 34209
Phone: (941) 792-9125
Fax: (941) 798-9184
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 34209)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	FL	85610	Blood test, clotting time	80	12
FAMILY MEDICINE	FL	94060	Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration	16	11

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Frequently asked questions

How is Unknown Individual identified in CMS data?

CMS-hosted NPPES data lists Unknown Individual with NPI 1366496317.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

What area does Unknown Individual serve?

Unknown Individual's listing highlights Bradenton, Florida; more addresses can appear in NPPES.

What does 'Individual Provider' mean on this profile?

Entity type tells you whether the number belongs to a person or an organization.