Unknown Individual – Adult Psychiatric/Mental Health Clinical Nurse Specialist, NPI 1487894614

Unknown Individual is a healthcare provider. based in Roslindale, Massachusetts. specializing in Adult Psychiatric/Mental Health Clinical Nurse Specialist. They hold a License No. 252128 (MA). The NPI Number for Unknown Individual is 1487894614

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1487894614
Phone
(617) 767-2793
Address
24 FAIRVIEW ST
Deactivation Date
15 November 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6174794545
Graduation Year
2004 (22 years ago)
PAC ID
9436295136
Group Practice PAC ID
4183524887
Professional Enrollment ID
I20091012000062
Data current as of
20 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

  • 24, Fairview Street, Roslindale, Boston, Suffolk County, Massachusetts, 02131, United States

    ROSLINDALE, MA 021311629

    Phone: (617) 767-2793

    Type: Mailing

  • 1261, Furnace Brook Parkway, North Commons, Quincy, Norfolk County, Massachusetts, 02169, United States

    SUITE #31

    QUINCY, MA 021694721

    Phone: (617) 479-4545

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $21.

Total Amount is formed as General ($21) + Research ($0) + Ownership ($0) = $21.

Last reported payment date: 2024-06-04 • Largest payer in this snapshot: Eisai Inc. ($21).

Total Amount

$21

General + Research + Ownership

Payments

1

Total payment records

General Amount

$21

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-06-04

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Eisai Inc.$21
View all Open Payments →|Open Payments Risk Radar →

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
99214Established patient office or other outpatient visit, 30-39 minutes19759$0
View full utilization report →

Insurance plans in this area (ZIP 02131)

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Provider's Procedures

Unknown Individual performs procedures in Adult Psychiatric/Mental Health Clinical Nurse Specialist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CERTIFIED CLINICAL NURSE SPECIALISTMA90792Psychiatric diagnostic evaluation with medical services2626

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: 4183524887View full group profile
NameSpecialtyState
Nurse PractitionerMA
Clinical PsychologistMA
-MA
Clinical Social WorkerMA
Clinical Social WorkerMA
-MA
-MA
Clinical PsychologistVA
Clinical Social WorkerMA
Nurse PractitionerMA

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1487894614 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Adult Psychiatric/Mental Health Clinical Nurse Specialist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Roslindale?
Public fields place Unknown Individual around Roslindale, Massachusetts. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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