Unknown Individual – General Practice Physician, NPI 1417948480

General Practice Physician

Unknown Individual is a healthcare provider. based in Clermont, Florida. specializing in General Practice Physician. They hold a License No. ME84962 (FL). The NPI Number for Unknown Individual is 1417948480

Main info

Organization

Inactive

36 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417948480

Phone

(321) 235-6230

Address

701 E SR 50 Ste 731C

Deactivation Date

2 December 2020

Doctor Profile

Medical School Name

OTHER

Secondary Phone

3212356230

Graduation Year

1990 (36 years ago)

PAC ID

4587729975

Group Practice PAC ID

9032274428

Professional Enrollment ID

I20090218000655

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience19

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

701 E SR 50 Ste 731C
Clermont, FL 347113165
Phone: (321) 235-6230
Fax: (321) 235-6246
Type: Location
4227 13th St
Saint Cloud, FL 347696732
Phone: (321) 235-6230
Fax: (321) 235-6246
Type: Location
East Grant Street, Orlando, Orange County, Florida, 32806, United States
ORLANDO, FL 328221666
Phone: (321) 235-6230
Fax: (321) 235-6246
Type: Mailing
Grant Street, Lake Fredrica, Orlando, Orange County, Florida, 32807, United States
ORLANDO, FL 328221666
Phone: (321) 235-6230
Fax: (321) 235-6246
Type: Location
865 Buenaventura Blvd
Kissimmee, FL 347438125
Phone: (321) 235-6230
Fax: (321) 235-6246
Type: Location
2710 N Orange Blossom Trl
Kissimmee, FL 347441349
Phone: (321) 235-6230
Fax: (321) 234-6246
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 34711)

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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: 9032274428View full group profile