Unknown Individual – Physician Assistant, NPI 1730117078

Unknown Individual is a healthcare provider. based in New smyrna beach, Florida. specializing in Physician Assistant. They hold a License No. :PA9101755 (FL). The NPI Number for Unknown Individual is 1730117078

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1730117078
Phone
(727) 623-6399
Address
830 E 26TH AVE
Deactivation Date
7 August 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3864261411
Graduation Year
2001 (25 years ago)
PAC ID
4082514385
Group Practice PAC ID
2365417391
Professional Enrollment ID
I20040112000420
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

  • 830, East 26th Avenue, New Smyrna Beach, Volusia County, Florida, 32169, United States

    NEW SMYRNA BEACH, FL 321693616

    Phone: (727) 623-6399

    Type: Mailing

  • 812, West Indian River Boulevard, Edgewater, Volusia County, Florida, 32141, United States

    EDGEWATER, FL 321323429

    Phone: (386) 426-1411

    Fax: (376) 426-0457

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes144104$0
20611Aspiration and/or injection of fluid large joint using ultrasound guidance5830$0
99213Established patient office or other outpatient visit, 20-29 minutes4038$0
76882Limited ultrasound scan of joint or other extremity structure except blood vessels2317$0
20552Injection of trigger points, 1-2 muscles1412$0
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Insurance plans in this area (ZIP 32169)

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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: 2365417391View full group profile
NameSpecialtyState
Physician AssistantFL
Orthopedic SurgeryFL

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1730117078.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Physician Assistant. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists New Smyrna Beach, Florida for Unknown Individual; download NPPES for the complete set.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1730117078. Always confirm identity and privileges with the practice and licensing boards.

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