Unknown Individual – Emergency Medicine Physician, NPI 1255379574

Unknown Individual is a healthcare provider. based in Ware, Massachusetts. specializing in Emergency Medicine Physician. They hold a License No. 56374 (MA). The NPI Number for Unknown Individual is 1255379574

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255379574
Phone
(413) 967-6211
Address
85 SOUTH STREET
Deactivation Date
25 August 2021

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
Secondary Phone
4132837651
Graduation Year
1983 (43 years ago)
PAC ID
3779530977
Group Practice PAC ID
9335048321
Professional Enrollment ID
I20050331000066
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

  • 85, South Street, Ware, Hampshire County, Massachusetts, 01082, United States

    WARE, MA 010821625

    Phone: (413) 967-6211

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 01082)

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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: 9335048321View full group profile
NameSpecialtyState
Mental Health CounselorMA
-MA
-MA
-MA
Emergency MedicineMA
-MA
Clinical PsychologistMA
-MA
Clinical Social WorkerMA
Mental Health CounselorMA

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1255379574 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Emergency Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Ware?
Unknown Individual currently maps to Ware, Massachusetts in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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