Unknown Individual – Vascular Surgery Physician, NPI 1396940763

Unknown Individual is a healthcare provider. based in Stoneham, Massachusetts. specializing in Vascular Surgery Physician. They hold a License No. MT180349T (PA). The NPI Number for Unknown Individual is 1396940763

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396940763
Phone
(781) 620-4702
Address
91 MONTVALE AVE STE 208
Deactivation Date
14 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7813066180
Graduation Year
2002 (24 years ago)
PAC ID
7214074277
Group Practice PAC ID
4385638782
Professional Enrollment ID
I20091023000026
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

  • 91 MONTVALE AVE STE 208

    STONEHAM, MA 021803649

    Phone: (781) 620-4702

    Fax: (781) 438-3125

    Type: Mailing

  • 91, Montvale Avenue, Nobility Hill Historic District, Lindenwood, Stoneham, Middlesex County, Massachusetts, 02180, United States

    SUITE 208

    STONEHAM, MA 021803623

    Phone: (781) 620-4702

    Fax: (781) 438-3125

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes121118$0
93880Ultrasound of both sides of head and neck blood flow4443$0
99203New patient office or other outpatient visit, 30-44 minutes3737$0
93979Ultrasound of aorta, vena cava, groin vessels or bypass grafts2525$0
99214Established patient office or other outpatient visit, 30-39 minutes2424$0
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Insurance plans in this area (ZIP 02180)

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Provider's Procedures

Unknown Individual performs procedures in Vascular Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
VASCULAR SURGERYMA93922Ultrasound study of arteries of both arms and legs1211
VASCULAR SURGERYMA93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers6261

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: 4385638782View full group profile
NameSpecialtyState
Cardiovascular Disease (Cardiology), Interventional CardiologyMA
-MA
O B S T E T R I C S/ G Y N E C O L O G YMA
-MA
Family PracticeNM
-MA
-MA
Family PracticeMA
-MA
Physician AssistantMA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1396940763 — is the standard way to identify this listing.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Vascular Surgery Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Stoneham, Massachusetts in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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DR. RONALD L NATH (M.D.)

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