Unknown Individual – Diagnostic Radiology Physician, NPI 1205848058

Unknown Individual is a healthcare provider. based in Port huron, Michigan. specializing in Diagnostic Radiology Physician. They hold a License No. 062381 (MI). The NPI Number for Unknown Individual is 1205848058

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205848058
Phone
(810) 985-0029
Address
1530 PINE GROVE AVE
Deactivation Date
16 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8103297111
Graduation Year
1982 (44 years ago)
PAC ID
0749224905
Group Practice PAC ID
5395789531
Professional Enrollment ID
I20050617000976
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

  • Visiting Angels Senior Home Care Port Huron, 1530, Pine Grove Avenue, Port Huron, Saint Clair County, Michigan, 48060, United States

    SUITE 7

    PORT HURON, MI 48060

    Phone: (810) 985-0029

    Fax: (810) 985-0032

    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 48060)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYMI71010X-ray of chest, 1 view, front525433
DIAGNOSTIC RADIOLOGYMI71250CT scan chest5250
DIAGNOSTIC RADIOLOGYMI73110X-ray of wrist, minimum of 3 views2323
DIAGNOSTIC RADIOLOGYMI73562X-ray of knee, 3 views5246
DIAGNOSTIC RADIOLOGYMI73630X-ray of foot, minimum of 3 views6354
DIAGNOSTIC RADIOLOGYMI78452Nuclear medicine study of vessels of heart using drugs or exercise multiple studies2525
DIAGNOSTIC RADIOLOGYMI78815Nuclear medicine study with CT imaging skull base to mid-thigh1717

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: 5395789531View full group profile
NameSpecialtyState
Diagnostic RadiologyMI
Diagnostic RadiologyMI
Diagnostic RadiologyVA
Diagnostic RadiologyPA
Diagnostic RadiologyMI
-MI
Diagnostic RadiologyMI
Diagnostic RadiologyMI
Diagnostic RadiologyMI

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1205848058 if you need a stable reference for Unknown Individual.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Michigan?
You will see Port Huron, Michigan on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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