Unknown Individual – Pulmonary Disease Physician, NPI 1245291830

Pulmonary Disease Physician

Unknown Individual is a healthcare provider. based in Boise, Idaho. specializing in Pulmonary Disease Physician. They hold a License No. 86-174495-1205 (UT). The NPI Number for Unknown Individual is 1245291830

Main info

Organization

Inactive

48 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1245291830

Phone

(208) 302-2000

Address

1055 N Curtis Rd

Deactivation Date

17 July 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2032764644

Graduation Year

1978 (48 years ago)

PAC ID

8729256599

Group Practice PAC ID

6901099746

Professional Enrollment ID

I20200428001435

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience37

Completeness75

Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

1055 N Curtis Rd
Boise, ID 837061309
Phone: (208) 302-2000
Fax: (208) 302-2055
Type: Location
Naval Hospital Jacksonville, 2080, Child Street, Jacksonville, Duval County, Florida, 32214, United States
JACKSONVILLE, FL 322145005
Phone: (904) 542-7654
Fax: (904) 542-7913
Type: Mailing

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.

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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 83706)

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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: 6901099746View full group profile

Name	Specialty	State
COLLEEN DELANEY (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	CT
FAHMIDA BEGUM (PA)	Physician Assistant	CT
RODRIGO ACOSTA (M.D.)	Family Practice	CT
GREGORY JUDE JENKINS (PA)	Physician Assistant	CT
DR. MICHAEL KOFI ADUSEI (M.D.)	P S Y C H I A T R Y	CT
JACLYN MARIE MUNOZ (MD)	O B S T E T R I C S/ G Y N E C O L O G Y	CT
JANINE MARIE POPOT (M.D.)	O B S T E T R I C S/ G Y N E C O L O G Y	CT
MR. MICHAEL ADAM BERGMAN (PA-C)	Physician Assistant	CT
ALFRED BIRCAJ (MD)	Internal Medicine	NY
MRS. KATHLEEN M STUART (PMHNP-BC)	Nurse Practitioner	CT