Unknown Individual – Specialist, NPI 1558475913

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Specialist. They hold a License No. 8163 (NV). The NPI Number for Unknown Individual is 1558475913

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1558475913
Phone
(702) 360-6100
Address
2625 BOX CANYON DR
Deactivation Date
8 March 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7023606100
Graduation Year
1986 (40 years ago)
PAC ID
6305808882
Group Practice PAC ID
4789646266
Professional Enrollment ID
I20050110000157
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

  • 2625, Box Canyon Drive, Las Vegas, Clark County, Nevada, 89128, United States

    LAS VEGAS, NV 891280450

    Phone: (702) 360-6100

    Fax: (702) 360-8096

    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 3 Open Payments records for all available years, with a total value of $69.

Total Amount is formed as General ($69) + Research ($0) + Ownership ($0) = $69.

Last reported payment date: 2023-01-12 • Largest payer in this snapshot: CSL Behring ($33).

Total Amount

$69

General + Research + Ownership

Payments

3

Total payment records

General Amount

$69

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-01-12

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
95117Professional service for multiple injections of allergen6246$0
99213Established patient office or other outpatient visit, 20-29 minutes1313$0
94010Test to measure expiratory airflow and volume1212$0
View full utilization report →

Insurance plans in this area (ZIP 89128)

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Provider's Procedures

Unknown Individual performs procedures in Specialist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ALLERGY/IMMUNOLOGYNV94060Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration205183
ALLERGY/IMMUNOLOGYNV95117Injection of incremental dosages of allergen, 2 or more injections105654

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: 4789646266View full group profile
NameSpecialtyState
-NV
A L L E R G Y/ I M M U N O L O G YNV
Physician AssistantNV

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1558475913.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Other Service Providers. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Las Vegas, Nevada; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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