Unknown Individual – Emergency Medicine Physician, NPI 1619963097

Unknown Individual is a healthcare provider. based in Coral springs, Florida. specializing in Emergency Medicine Physician. They hold a License No. ME50332 (FL). The NPI Number for Unknown Individual is 1619963097

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619963097
Phone
Not provided
Address
6310 NW 120TH DR
Deactivation Date
1 July 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5615483549
Graduation Year
1977 (49 years ago)
PAC ID
0446249395
Group Practice PAC ID
2860623774
Professional Enrollment ID
I20040507000205
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

  • 6310, Northwest 120th Drive, Heron Bay South, Coral Springs, Broward County, Florida, 33076, United States

    CORAL SPRINGS, FL 330761909

    Phone:

    Type: Mailing

  • Broward Health Coral Springs, 3000, Coral Hills Drive, Coral Springs, Broward County, Florida, 33065, United States

    CORAL SPRINGS ED

    CORAL SPRINGS, FL 330654108

    Phone: (954) 344-3000

    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 33076)

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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: 2860623774View full group profile

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1619963097.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Coral Springs, Florida as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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