Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1124197207

Unknown Individual is a healthcare provider. based in Stoneham, Massachusetts. specializing in Psychiatric/Mental Health Nurse Practitioner. They hold a License No. 6062 (MA). The NPI Number for Unknown Individual is 1124197207

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124197207
Phone
(617) 501-2059
Address
80 PINE ST # 1
Deactivation Date
11 January 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9788517321
Graduation Year
2009 (17 years ago)
PAC ID
2466589916
Group Practice PAC ID
8820906860
Professional Enrollment ID
I20100415000134
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 80 PINE ST # 1

    STONEHAM, MA 021802639

    Phone: (617) 501-2059

    Type: Mailing

  • 80, Pine Street, Central Square Historic District, Lindenwood, Stoneham, Middlesex County, Massachusetts, 02180, United States

    1

    STONEHAM, MA 021802639

    Phone: (617) 501-2059

    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 02180)

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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: 8820906860View full group profile

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1124197207.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Psychiatric/Mental Health Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Stoneham, Massachusetts in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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