Unknown Individual – Psychiatry Physician, NPI 1104883883

Unknown Individual is a healthcare provider. based in Cumberland, Maryland. specializing in Psychiatry Physician. They hold a License No. D0005139 (MD). The NPI Number for Unknown Individual is 1104883883

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104883883
Phone
(301) 723-5030
Address
900 SETON DR
Deactivation Date
28 August 2024

Doctor Profile

Medical School Name
GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2409641200
Graduation Year
1968 (58 years ago)
PAC ID
2365487345
Group Practice PAC ID
7113900655
Professional Enrollment ID
I20120220000724
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

  • Allegany High School, 900, Seton Drive, Cumberland, Allegany County, Maryland, 21502, United States

    CUMBERLAND, MD 215021854

    Phone: (301) 723-5030

    Fax: (301) 723-6485

    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)

CMS reports 2 Open Payments records for all available years, with a total value of $54.

Total Amount is formed as General ($54) + Research ($0) + Ownership ($0) = $54.

Last reported payment date: 2024-06-13 • Largest payer in this snapshot: Indivior Inc. ($54).

Total Amount

$54

General + Research + Ownership

Payments

2

Total payment records

General Amount

$54

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-13

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Indivior Inc.$54
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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes467111$0
View full utilization report →

Insurance plans in this area (ZIP 21502)

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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: 7113900655View full group profile

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1104883883; it appears in the national provider directory.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Cumberland, Maryland for Unknown Individual; download NPPES for the complete set.
What if Cumberland, Maryland seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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