Unknown Individual – Adult Medicine Physician, NPI 1396771630

Unknown Individual is a healthcare provider. based in Pompano beach, Florida. specializing in Adult Medicine Physician. They hold a License No. OS6888 (FL). The NPI Number for Unknown Individual is 1396771630

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396771630
Phone
(954) 943-8737
Address
750 E SAMPLE RD BAY 6
Deactivation Date
9 December 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9546300311
Graduation Year
1993 (33 years ago)
PAC ID
8022156629
Group Practice PAC ID
0941450902
Professional Enrollment ID
I20091118000431
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

  • East Sample Road, North Pompano Beach, Pompano Beach, Broward County, Florida, 33064, United States

    POMPANO BEACH, FL 330645144

    Phone: (954) 943-8737

    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 33064)

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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: 0941450902View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1396771630.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Adult Medicine Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Pompano Beach, Florida in registry-derived data.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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