Unknown Individual – Hematology & Oncology Physician, NPI 1679594170

Unknown Individual is a healthcare provider. based in Crystal river, Florida. specializing in Hematology & Oncology Physician. They hold a License No. MD185090 (OR). The NPI Number for Unknown Individual is 1679594170

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1679594170
Phone
(352) 795-6674
Address
770 SE 5th Ter
Deactivation Date
27 September 2023

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
5412746262
Graduation Year
1975 (51 years ago)
PAC ID
5890750202
Group Practice PAC ID
1052204096
Professional Enrollment ID
I20180227000786
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 770 SE 5th Ter

    Crystal River, FL 344294852

    Phone: (352) 795-6674

    Fax: (352) 795-2017

    Type: Location

  • Sky Lakes Medical Center, 2865, Daggett Avenue, Klamath Falls, Klamath County, Oregon, 97601, United States

    KLAMATH FALLS, OR 976011106

    Phone: (541) 882-6311

    Fax: (541) 274-6247

    Type: Mailing

  • 2610, Uhrmann Road, Klamath Falls, Klamath County, Oregon, 97601, United States

    KLAMATH FALLS, OR 976011123

    Phone: (541) 274-4171

    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.

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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 34429)

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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: 1052204096View full group profile
NameSpecialtyState
Physician AssistantOR
Family PracticeOR
Nurse PractitionerOR
-OR
Internal MedicineOR
Family PracticeOR
-OR
-OR
Neurology, NeuropsychiatryFL
Diagnostic RadiologyOR

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1679594170.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Hematology & Oncology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Crystal River, Florida in the same public data insurers reference.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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