Unknown Individual – Family Medicine Physician, NPI 1184617854

Unknown Individual is a healthcare provider. based in Mount clemens, Michigan. specializing in Family Medicine Physician. They hold a License No. 5101005762 (MI). The NPI Number for Unknown Individual is 1184617854

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1184617854
Phone
(586) 468-8088
Address
247 N GRATIOT AVE
Deactivation Date
22 May 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1967 (59 years ago)
PAC ID
4981518768
Professional Enrollment ID
I20080110000147
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

  • North Gratiot Avenue, Mount Clemens, Clinton Township, Macomb County, Michigan, 48043, United States

    MOUNT CLEMENS, MI 480435746

    Phone: (586) 468-8088

    Fax: (586) 468-8283

    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)

CMS reports 5 Open Payments records for all available years, with a total value of $85.

Total Amount is formed as General ($85) + Research ($0) + Ownership ($0) = $85.

Last reported payment date: 2023-10-05 • Largest payer in this snapshot: IDORSIA PHARMACEUTICALS US INC ($35).

Total Amount

$85

General + Research + Ownership

Payments

5

Total payment records

General Amount

$85

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-10-05

Latest reported date

Top Companies

Largest payers in this snapshot

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
96372Injection of drug or substance under skin or into muscle35077$0
99213Established patient office or other outpatient visit, 20-29 minutes315110$0
86235Measurement of antibody for assessment of autoimmune disorder, any method20852$0
J0696Injection, ceftriaxone sodium, per 250 mg19051$0
36415Insertion of needle into vein for collection of blood sample9383$0
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Insurance plans in this area (ZIP 48043)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEMI82270Stool analysis for blood to screen for colon tumors5858
FAMILY MEDICINEMI94060Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration9694

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1184617854 for Unknown Individual, then check state licensing separately.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Mount Clemens, Michigan as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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