Unknown Individual – Specialist, NPI 1174521132

Unknown Individual is a healthcare provider. based in Augusta, Georgia. specializing in Specialist. They hold a License No. 018345 (GA). The NPI Number for Unknown Individual is 1174521132

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174521132
Phone
(706) 863-6637
Address
1109 MEDICAL CENTER DR
Deactivation Date
25 December 2025

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Secondary Phone
7068656637
Graduation Year
1975 (51 years ago)
PAC ID
7517937840
Group Practice PAC ID
7719957042
Professional Enrollment ID
I20040727000796
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

  • 1109, Medical Center Drive, Augusta, Richmond County, Georgia, 30909, United States

    BUILDING #5

    AUGUSTA, GA 309096633

    Phone: (706) 863-6637

    Fax: (706) 863-6638

    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)

CMS reports 5 Open Payments records for all available years, with a total value of $88.

Total Amount is formed as General ($88) + Research ($0) + Ownership ($0) = $88.

Last reported payment date: 2024-10-09 • Largest payer in this snapshot: Fresenius USA Marketing, Inc. ($54).

Total Amount

$88

General + Research + Ownership

Payments

5

Total payment records

General Amount

$88

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-09

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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 minutes12485$0
View full utilization report →

Insurance plans in this area (ZIP 30909)

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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: 7719957042View full group profile
NameSpecialtyState
N E P H R O L O G YGA
Internal Medicine, NephrologyGA

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1174521132.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Other Service Providers. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Augusta, Georgia in registry-derived data.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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