Unknown Individual – Ophthalmology Physician, NPI 1689792228

Unknown Individual is a healthcare provider. based in Saint clair shores, Michigan. specializing in Ophthalmology Physician. They hold a License No. 5101015591 (MI). The NPI Number for Unknown Individual is 1689792228

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1689792228
Phone
(586) 774-2020
Address
25511 LITTLE MACK AVE
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
2483324544
Graduation Year
2003 (23 years ago)
PAC ID
9234230731
Group Practice PAC ID
2466410840
Professional Enrollment ID
I20070727000632
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

Provider Addresses for Unknown Individual

  • 25511 LITTLE MACK AVE

    SAINT CLAIR SHORES, MI 480813372

    Phone: (586) 774-2020

    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 19 Open Payments records for all available years, with a total value of $13,322.

Total Amount is formed as General ($13,322) + Research ($0) + Ownership ($0) = $13,322.

Last reported payment date: 2024-10-17 • Largest payer in this snapshot: Baxter Healthcare ($13,153).

Total Amount

$13,322

General + Research + Ownership

Payments

19

Total payment records

General Amount

$13,322

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-17

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
99214Established patient office or other outpatient visit, 30-39 minutes8673$0
99213Established patient office or other outpatient visit, 20-29 minutes6938$0
92133Imaging of optic nerve3534$0
92250Photography of the retina3028$0
92083Exam of visual field with extended testing2927$0
View full utilization report →

Insurance plans in this area (ZIP 48081)

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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: 2466410840View full group profile
NameSpecialtyState
O P H T H A L M O L O G YMI
O P H T H A L M O L O G YMI
O P H T H A L M O L O G YMI
O P T O M E T R YMI

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1689792228 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 Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Saint Clair Shores, Michigan.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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