Unknown Individual – Physician Assistant, NPI 1043229677

Unknown Individual is a healthcare provider. based in Beverly, Massachusetts. specializing in Physician Assistant. They hold a License No. 1011 (MA). The NPI Number for Unknown Individual is 1043229677

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043229677
Phone
(978) 927-8844
Address
900 CUMMINGS CTR STE 112W
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9789278844
Graduation Year
1993 (33 years ago)
PAC ID
6608884366
Group Practice PAC ID
7810993599
Professional Enrollment ID
I20070109000148
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

  • 900 CUMMINGS CTR STE 112W

    BEVERLY, MA 019156183

    Phone: (978) 927-8844

    Type: Mailing

  • 900 Cummings Center, Cummings Center, Rial Side, Beverly, Essex County, Massachusetts, 01915-4202, United States

    BEVERLY, MA 019156198

    Phone: (978) 927-8841

    Type: Location

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 01915)

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Provider's Procedures

Unknown Individual performs procedures in Physician Assistant. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICIAN ASSISTANTMA17003Destruction of 2-14 skin growths3613

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: 7810993599View full group profile
NameSpecialtyState
-MA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1043229677.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Physician Assistant. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Massachusetts?
You will see Beverly, Massachusetts on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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