Unknown Individual – Surgery Physician, NPI 1215990981

Unknown Individual is a healthcare provider. based in Meridian, Idaho. specializing in Surgery Physician. They hold a License No. M-6572 (ID). The NPI Number for Unknown Individual is 1215990981

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215990981
Phone
(208) 302-2700
Address
3340 E GOLDSTONE WAY
Deactivation Date
23 October 2025

Doctor Profile

Medical School Name
UNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Secondary Phone
2083020600
Graduation Year
1986 (40 years ago)
PAC ID
2365488095
Group Practice PAC ID
3476462359
Professional Enrollment ID
I20050705000558
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

  • 3340 E GOLDSTONE WAY

    MERIDIAN, ID 836421026

    Phone: (208) 302-2700

    Fax: (208) 302-2725

    Type: Mailing

  • 4400, East Flamingo Avenue, Nampa, Canyon County, Idaho, 83687, United States

    STE 200

    NAMPA, ID 83687

    Phone: (208) 302-2700

    Fax: (208) 302-2725

    Type: Location

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.

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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 83642)

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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: 3476462359View full group profile

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1215990981.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Surgery Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Meridian, Idaho?
If you are local to Meridian, Idaho, Unknown Individual may be relevant to your search.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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