Unknown Individual – Sleep Medicine (Family Medicine) Physician, NPI 1912008079

Unknown Individual is a healthcare provider. based in Moscow, Idaho. specializing in Sleep Medicine (Family Medicine) Physician. They hold a License No. M6614 (ID). The NPI Number for Unknown Individual is 1912008079

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1912008079
Phone
(208) 882-7565
Address
213 N Main St
Deactivation Date
9 January 2025

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
Secondary Phone
2088824511
Graduation Year
1973 (53 years ago)
PAC ID
3274512744
Group Practice PAC ID
8729070164
Professional Enrollment ID
I20080806000113
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 213 N Main St

    Moscow, ID 838432700

    Phone: (208) 882-7565

    Fax: (208) 882-7567

    Type: Location

  • Gritman Medical Center, 700, South Main Street, Moscow, Latah County, Idaho, 83843, United States

    MOSCOW, ID 838433046

    Phone: (208) 883-6359

    Fax: (208) 883-6580

    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.

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 83843)

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Provider's Procedures

Unknown Individual performs procedures in Sleep Medicine (Family Medicine) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEID81002Urinalysis, manual test1411

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: 8729070164View full group profile

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1912008079.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Sleep Medicine (Family Medicine) Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Moscow?
Public fields place Unknown Individual around Moscow, Idaho. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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