Unknown Individual – Internal Medicine Physician, NPI 1528061611

Unknown Individual is a healthcare provider. based in Cumming, Georgia. specializing in Internal Medicine Physician. They hold a License No. 41147 (GA). The NPI Number for Unknown Individual is 1528061611

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1528061611
Phone
(678) 455-0030
Address
106 PILGRIM VILLAGE DR
Deactivation Date
5 June 2024

Doctor Profile

Medical School Name
UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Secondary Phone
6784550030
Graduation Year
1991 (35 years ago)
PAC ID
4082777263
Group Practice PAC ID
4284951542
Professional Enrollment ID
I20090114000435
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

  • Pilgrim Village Drive, Cumming, Forsyth County, Georgia, 300410, United States of America

    SUITE 400

    CUMMING, GA 300409241

    Phone: (678) 455-0030

    Fax: (678) 455-0033

    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 4 Open Payments records for all available years, with a total value of $77.

Total Amount is formed as General ($77) + Research ($0) + Ownership ($0) = $77.

Last reported payment date: 2024-03-20 • Largest payer in this snapshot: Corium, LLC ($28).

Total Amount

$77

General + Research + Ownership

Payments

4

Total payment records

General Amount

$77

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-20

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
99213Established patient office or other outpatient visit, 20-29 minutes4534$0
99214Established patient office or other outpatient visit, 30-39 minutes3529$0
View full utilization report →

Insurance plans in this area (ZIP 30040)

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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: 4284951542View full group profile
NameSpecialtyState
Nurse PractitionerGA
-GA
Nurse PractitionerGA
Diagnostic RadiologyGA
Nurse PractitionerGA
Internal MedicineGA
Internal Medicine, Allergy/ImmunologyGA
General PracticeGA
Nurse PractitionerGA
Internal MedicineGA

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1528061611 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Cumming?
Public fields place Unknown Individual around Cumming, Georgia. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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