Unknown Individual – Internal Medicine Physician, NPI 1457399743

Internal Medicine Physician

Unknown Individual is a healthcare provider. based in Celebration, Florida. specializing in Internal Medicine Physician. They hold a License No. ME92504 (FL). The NPI Number for Unknown Individual is 1457399743

Main info

Organization

Inactive

34 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1457399743

Phone

(407) 303-4901

Address

400 CELEBRATION PL

Deactivation Date

12 June 2024

Doctor Profile

Medical School Name

GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

4072002700

Graduation Year

1992 (34 years ago)

PAC ID

3971521741

Group Practice PAC ID

0749186153

Professional Enrollment ID

I20051110000126

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

Loading map...

Provider Addresses for Unknown Individual

Florida Hospital Celebration Health, 400, Celebration Place, Kissimmee, Reedy Creek Improvement District, Osceola County, Florida, 34747, United States
SUITE A350
CELEBRATION, FL 347474970
Phone: (407) 303-4901
Fax: (407) 303-4909
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 34747)

Loading plans...

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: 0749186153View full group profile

Name	Specialty	State
ALLEN GENE III JORDAN (PA-C)	Physician Assistant	FL
ANWAR AHMED (M.D.)	N E U R O L O G Y	FL
DR. MICHAEL GREGG (M.D.)	General Surgery	FL
BASIEM WILLIAM BARSOUM (MD)	Cardiovascular Disease (Cardiology), Internal Medicine, Interventional Cardiology	FL
KAITLYN SCHWEIGER (APRN)	Nurse Practitioner	FL
DR. MICHELLE MERSCH (DO)	O B S T E T R I C S/ G Y N E C O L O G Y	FL
DR. JASON ANDREW BOARDMAN (M.D)	General Surgery	FL
DR. PRANAV PATEL (MD)	Pulmonary Disease, Critical Care (Intensivists)	FL
DR. REBECCAH BRISKIN (DO)	O B S T E T R I C S/ G Y N E C O L O G Y	MI
ANGELA C. KREBS (PA-C)	Physician Assistant	FL