Unknown Individual – Clinical Psychologist, NPI 1225093800

Unknown Individual is a healthcare provider. based in Omaha, Nebraska. specializing in Clinical Psychologist. They hold a License No. 77 (NE). The NPI Number for Unknown Individual is 1225093800

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1225093800
Phone
(402) 330-1537
Address
12728 AUGUSTA AVE
Deactivation Date
20 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1978 (48 years ago)
PAC ID
7517929979
Professional Enrollment ID
I20100525000405
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

  • 12728, Augusta Avenue, Millard, Omaha, Douglas County, Nebraska, 68144, United States

    STE 150

    OMAHA, NE 681443750

    Phone: (402) 330-1537

    Fax: (402) 330-9331

    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.

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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 68144)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1225093800 is assigned to Unknown Individual under the national enumeration system.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Omaha, Nebraska because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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