Unknown Individual – Clinical Social Worker, NPI 1104187772

Unknown Individual is a healthcare provider. based in Pinckney, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801046528 (MI). The NPI Number for Unknown Individual is 1104187772

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104187772
Phone
(734) 476-7745
Address
1265 BEULAH
Deactivation Date
3 December 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8102202787
Graduation Year
1978 (48 years ago)
PAC ID
6204135478
Group Practice PAC ID
7911995139
Professional Enrollment ID
I20160422001322
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

Provider Addresses for Unknown Individual

  • 1265 BEULAH

    PINCKNEY, MI 481699030

    Phone: (734) 476-7745

    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 48169)

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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: 7911995139View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1104187772 on file in the registry.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Pinckney?
Unknown Individual currently maps to Pinckney, Michigan in this extract.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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