Unknown Individual – Psychiatry Physician, NPI 1124085741

Unknown Individual is a healthcare provider. based in South portland, Maine. specializing in Psychiatry Physician. They hold a License No. 017962 (ME). The NPI Number for Unknown Individual is 1124085741

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124085741
Phone
(207) 842-6556
Address
78 ATLANTIC PLACE
Deactivation Date
7 September 2022

Doctor Profile

Medical School Name
TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
9013848040
Graduation Year
1965 (61 years ago)
PAC ID
7719024983
Group Practice PAC ID
1456313006
Professional Enrollment ID
I20151117001073
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

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Provider Addresses for Unknown Individual

  • 78, Atlantic Place, South Portland, Cumberland County, Maine, 04106, United States

    SOUTH PORTLAND, ME 041062316

    Phone: (207) 842-6556

    Fax: (207) 842-7773

    Type: Mailing

  • Maine Behavioral Healthcare, 12, Union Street, Rockland, Knox County, Maine, 04841, United States

    ROCKLAND, ME 048412739

    Phone: (207) 701-4402

    Fax: (207) 701-4486

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $16.

Total Amount is formed as General ($16) + Research ($0) + Ownership ($0) = $16.

Last reported payment date: 2023-02-24 • Largest payer in this snapshot: ABBVIE INC. ($16).

Total Amount

$16

General + Research + Ownership

Payments

1

Total payment records

General Amount

$16

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-02-24

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$16
View all Open Payments →|Open Payments Risk Radar →

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 04106)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYME90833Psychotherapy, 30 minutes with patient and/or family member6025

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: 1456313006View full group profile
NameSpecialtyState
Nurse PractitionerTN
P S Y C H I A T R YTN
P S Y C H I A T R YAR
Nurse PractitionerTN
Nurse PractitionerTN
Clinical PsychologistTN

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 1124085741.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in South Portland, Maine?
For routing, start with South Portland, Maine for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.