Unknown Individual – Family Medicine Physician, NPI 1083697486

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Winchester, Massachusetts. specializing in Family Medicine Physician. They hold a License No. 9532 (MA). The NPI Number for Unknown Individual is 1083697486

Main info

Organization

Inactive

48 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1083697486

Phone

(781) 721-4616

Address

259 SWANTON ST

Deactivation Date

18 September 2024

Doctor Profile

Medical School Name

LOYOLA UNIVERSITY OF CHICAGO, STRITCH SCHOOL OF MEDICINE

Secondary Phone

9786641990

Graduation Year

1978 (48 years ago)

PAC ID

2567451883

Group Practice PAC ID

4486540994

Professional Enrollment ID

I20040511000591

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

259, Swanton Street, Winchester, Middlesex County, Massachusetts, 01890, United States
WINCHESTER, MA 018904301
Phone: (781) 721-4616
Fax: (781) 721-2687
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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
99214	Established patient office or other outpatient visit, 30-39 minutes	273	151	$0
G0439	Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	110	110	$0
G0008	Administration of influenza virus vaccine	61	60	$0
G0444	Annual depression screening, 5 to 15 minutes	55	55	$0
90662	Influenza vaccine split virus, preservative free	53	52	$0

View full utilization report →

Insurance plans in this area (ZIP 01890)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	MA	90670	Pneumococcal vaccine for injection into muscle	35	35

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: 4486540994View full group profile

Name	Specialty	State
VICTOR KIM (M.D.)	-	MA
MEAGHAN EMILY WHEELER (PA-C)	-	MA
TAMARIE WHEAT	-	MA
TAN DIEM PHAM (MD)	-	MA
KATHLEEN M SLOPER (NP)	-	MA
MICHAEL HENRY BRESNAHAN (MD)	-	MA
JODY NAIMARK (M.D.)	-	MA
BRIAN JOHN CASSERLY (MD)	-	MA
MALORIE BARTLETT (MSN, APRN, FNP-C)	-	MA
JOEL SOLOMON (M.D.)	-	MA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1083697486 — is the standard way to identify this listing.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

Where is Unknown Individual based?

Unknown Individual is tied to Winchester, Massachusetts in the data we show; additional addresses may exist on the full record.

Is specialty guaranteed by NPI alone?

Taxonomy selections describe intent; scope of practice still follows state law.