Unknown Individual – Orthopaedic Surgery Physician, NPI 1124190855

Unknown Individual is a healthcare provider. based in Driggs, Idaho. specializing in Orthopaedic Surgery Physician. They hold a License No. M-7121 (ID). The NPI Number for Unknown Individual is 1124190855

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124190855
Phone
(208) 354-6352
Address
120 EAST HOWARD AVENUE
Deactivation Date
7 September 2022

Doctor Profile

Medical School Name
GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2083542302
Graduation Year
1988 (38 years ago)
PAC ID
1355326422
Group Practice PAC ID
3870744956
Professional Enrollment ID
I20081119000912
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Teton Valley Hospital, 120, East Howard Avenue, Driggs, Teton County, Idaho, 83422, United States

    TETON VALLEY HEALTH CARE

    DRIGGS, ID 834225112

    Phone: (208) 354-6352

    Fax: (208) 354-3158

    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 83422)

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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: 3870744956View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeID
Family PracticeID
H O S P I T A L I S TAZ
Physician AssistantID
Physical Therapist In Private PracticeID
D E R M A T O L O G YID
-UT
Family PracticeID
Internal MedicineID
Physical Therapist In Private PracticeIL

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1124190855 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Driggs, Idaho may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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