Unknown Individual – Diagnostic Radiology Physician, NPI 1053301820

Unknown Individual is a healthcare provider. based in Macon, Georgia. specializing in Diagnostic Radiology Physician. They hold a License No. 031893 (GA). The NPI Number for Unknown Individual is 1053301820

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053301820
Phone
(478) 743-1458
Address
770 PINE ST STE 290
Deactivation Date
3 July 2024

Doctor Profile

Medical School Name
BAYLOR COLLEGE OF MEDICINE
Secondary Phone
4787461020
Graduation Year
1984 (42 years ago)
PAC ID
2860390705
Group Practice PAC ID
5597752261
Professional Enrollment ID
I20031230000157
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

  • Pine Street, Callao, Macon County, Missouri, United States

    ATTN: RADIOLOGY DEPARTMENT

    MACON, GA 312017516

    Phone: (478) 743-1458

    Fax: (478) 755-1332

    Mailing address matches the actual address.

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 31201)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYGA71010X-ray of chest, 1 view, front774667
DIAGNOSTIC RADIOLOGYGA71250CT scan chest4747
DIAGNOSTIC RADIOLOGYGA73110X-ray of wrist, minimum of 3 views1616
DIAGNOSTIC RADIOLOGYGA73630X-ray of foot, minimum of 3 views3130
DIAGNOSTIC RADIOLOGYGA93922Ultrasound study of arteries of both arms and legs4443

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: 5597752261View full group profile
NameSpecialtyState
Diagnostic RadiologyGA
Diagnostic RadiologyGA
-GA
-GA
Diagnostic RadiologyMN
-GA
Diagnostic RadiologyMN
Diagnostic RadiologyMN
Diagnostic RadiologyMO
Diagnostic RadiologyGA

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 1053301820.
Should I call the clinic if Unknown Individual is inactive here?
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 Diagnostic Radiology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Macon, Georgia in registry-derived data.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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