Unknown Individual – Family Medicine Physician, NPI 1023019957

Unknown Individual is a healthcare provider. based in Twin falls, Idaho. specializing in Family Medicine Physician. They hold a License No. M3503 (ID). The NPI Number for Unknown Individual is 1023019957

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023019957
Phone
(208) 736-7422
Address
260 FALLS AVE STE C
Deactivation Date
20 December 2023

Doctor Profile

Medical School Name
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2087336700
Graduation Year
1973 (53 years ago)
PAC ID
4880834845
Group Practice PAC ID
6204172802
Professional Enrollment ID
I20130716000246
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

  • Twin Falls, Twin Falls County, Idaho, 83301, United States

    TWIN FALLS, ID 833013370

    Phone: (208) 736-7422

    Fax: (208) 736-8905

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes3230$0
99202New patient office or other outpatient visit, 15-29 minutes1515$0
99212Established patient office or other outpatient visit, 10-19 minutes1313$0
View full utilization report →

Insurance plans in this area (ZIP 83301)

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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: 6204172802View full group profile
NameSpecialtyState
-ID

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1023019957 on file in the registry.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Idaho is Unknown Individual registered?
Use Twin Falls, Idaho as the headline location for Unknown Individual here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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