Unknown Individual – Acute Care Nurse Practitioner, NPI 1356487979

Unknown Individual is a healthcare provider. based in West tisbury, Massachusetts. specializing in Acute Care Nurse Practitioner. They hold a License No. 242272 MA (MA). The NPI Number for Unknown Individual is 1356487979

Main info

Organization
Inactive
27 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356487979
Phone
(508) 627-5797
Address
PO BOX 1619
Deactivation Date
8 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5086275797111
Graduation Year
1999 (27 years ago)
PAC ID
3476569922
Group Practice PAC ID
3779562376
Professional Enrollment ID
I20060221000843
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

  • West Tisbury Post Office, 479, State Road, North Tisbury, West Tisbury, Dukes County, Massachusetts, 02575, United States

    WEST TISBURY, MA 025751619

    Phone: (508) 627-5797

    Type: Mailing

  • Stop & Shop, 245, Edgartown Vineyard Haven Road, Jerneganville, Edgartown, Dukes County, Massachusetts, 02539, United States

    EDGARTOWN, MA 025396941

    Phone: (508) 627-5797

    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 02575)

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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: 3779562376View full group profile
NameSpecialtyState
Family Practice, Geriatric MedicineNY
Nurse PractitionerMA
Clinical Social WorkerMA
Nurse PractitionerCA
Internal MedicineNY
-MA
Nurse PractitionerTX
O B S T E T R I C S/ G Y N E C O L O G YMA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1356487979 for Unknown Individual.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with West Tisbury, Massachusetts. Check all listed addresses for suites or satellite offices.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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