Unknown Individual – Family Medicine Physician, NPI 1912042409

Unknown Individual is a healthcare provider. based in Augusta, Maine. specializing in Family Medicine Physician. They hold a License No. 007296 (ME). The NPI Number for Unknown Individual is 1912042409

Main info

Organization
Inactive
72 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1912042409
Phone
(207) 626-1561
Address
15 E CHESTNUT ST
Deactivation Date
3 February 2022

Doctor Profile

Medical School Name
HARVARD MEDICAL SCHOOL
Secondary Phone
2076261870
Graduation Year
1954 (72 years ago)
PAC ID
7315199924
Group Practice PAC ID
1254245715
Professional Enrollment ID
I20121206000046
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 15 E CHESTNUT ST

    AUGUSTA, ME 043305736

    Phone: (207) 626-1561

    Fax: (207) 626-1849

    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 04330)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEME93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report7464

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: 1254245715View full group profile

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1912042409?
NPI 1912042409 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Augusta, Maine.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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