Unknown Individual – Nephrology Physician, NPI 1083604003

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Nephrology Physician. They hold a License No. 11069 (NV). The NPI Number for Unknown Individual is 1083604003

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083604003
Phone
(702) 877-1887
Address
500 S RANCHO DR
Deactivation Date
8 March 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7028771887
Graduation Year
1988 (38 years ago)
PAC ID
1456254754
Group Practice PAC ID
2961499322
Professional Enrollment ID
I20040929000714
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

  • 500, South Rancho Drive, Rancho Circle, Las Vegas, Clark County, Nevada, 89106, United States

    SUITE 12

    LAS VEGAS, NV 891064844

    Phone: (702) 877-1887

    Fax: (702) 877-4893

    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 89106)

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Provider's Procedures

Unknown Individual performs procedures in Nephrology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NEPHROLOGYNV81002Urinalysis, manual test4542

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: 2961499322View full group profile
NameSpecialtyState
-NV
Family PracticeNV
Nurse PractitionerNV
-NV
Nurse PractitionerNV
Nurse PractitionerNV
Nurse PractitionerNV
Nephrology, Internal MedicineNV
Nurse PractitionerNV
Nurse PractitionerNV

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1083604003.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Nephrology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Las Vegas, Nevada?
For routing, start with Las Vegas, Nevada for Unknown Individual, then verify phone and hours locally.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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