Unknown Individual – Internal Medicine Physician, NPI 1417095340

Unknown Individual is a healthcare provider. based in Lawrenceville, Georgia. specializing in Internal Medicine Physician. They hold a License No. 012937 (GA). The NPI Number for Unknown Individual is 1417095340

Main info

Organization
Inactive
60 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417095340
Phone
(770) 685-1300
Address
121 LANGLEY DR
Deactivation Date
1 November 2023

Doctor Profile

Medical School Name
MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Secondary Phone
7706851300
Graduation Year
1966 (60 years ago)
PAC ID
4486704061
Group Practice PAC ID
4688657471
Professional Enrollment ID
I20100708000316
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

  • 121, Langley Drive, Lawrenceville, Gwinnett County, Georgia, 30046, United States

    LAWRENCEVILLE, GA 300466930

    Phone: (770) 685-1300

    Fax: (770) 685-1311

    Type: Location

  • Lawrenceville Post Office, 2611, Main Street, Lawrenceville, Lawrence Township, Mercer County, New Jersey, 08648, United States

    LAWRENCEVILLE, GA 300461247

    Phone: (770) 685-1300

    Fax: (770) 685-1311

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 25 Open Payments records for all available years, with a total value of $488.

Total Amount is formed as General ($488) + Research ($0) + Ownership ($0) = $488.

Last reported payment date: 2023-08-15 • Largest payer in this snapshot: ABBVIE INC. ($142).

Total Amount

$488

General + Research + Ownership

Payments

25

Total payment records

General Amount

$488

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-08-15

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
99458Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes88989$0
99457Management using the results of remote vital sign monitoring per calendar month, first 20 minutes52294$0
99454Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days45696$0
36415Insertion of needle into vein for collection of blood sample209145$0
99214Established patient office or other outpatient visit, 30-39 minutes115107$0
View full utilization report →

Insurance plans in this area (ZIP 30046)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEGA20610Aspiration and/or injection of large joint or joint capsule2016
INTERNAL MEDICINEGA81002Urinalysis, manual test3424

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: 4688657471View full group profile
NameSpecialtyState
Nurse PractitionerGA
Nurse PractitionerGA
-GA
Internal MedicineGA
Internal Medicine, Pulmonary DiseaseGA

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1417095340 — the number used across U.S. healthcare to identify this provider.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Internal Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Lawrenceville, Georgia 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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