Unknown Individual – Family Medicine Physician, NPI 1114927878

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Athol, Massachusetts. specializing in Family Medicine Physician. They hold a License No. 51220 (MA). The NPI Number for Unknown Individual is 1114927878

Main info

Organization

Inactive

46 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1114927878

Phone

(978) 249-0099

Address

201 S MAIN ST

Deactivation Date

28 August 2025

Doctor Profile

Medical School Name

UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL

Secondary Phone

9782490099

Graduation Year

1980 (46 years ago)

PAC ID

4587639638

Group Practice PAC ID

1951376003

Professional Enrollment ID

I20050328000058

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

201, Main Street, Athol, Worcester County, Massachusetts, 01331, United States
STE 1
ATHOL, MA 013312117
Phone: (978) 249-0099
Fax: (978) 249-7227
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	532	283	$0
36415	Insertion of needle into vein for collection of blood sample	331	211	$0
85025	Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	188	146	$0
81003	Automated urinalysis test	179	149	$0
85610	Blood test, clotting time	155	16	$0

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Insurance plans in this area (ZIP 01331)

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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: 1951376003View full group profile