Unknown Individual – Specialist, NPI 1700991197

Unknown Individual is a healthcare provider. based in Las vegas, Nevada. specializing in Specialist. They hold a License No. 8684 (NV). The NPI Number for Unknown Individual is 1700991197

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1700991197
Phone
(702) 486-6000
Address
6161 W CHARLESTON BLVD
Deactivation Date
7 November 2022

Doctor Profile

Medical School Name
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3148434333
Graduation Year
1967 (59 years ago)
PAC ID
2860643426
Group Practice PAC ID
6608762547
Professional Enrollment ID
I20150702000284
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

  • 6161, West Charleston Boulevard, Charleston Heights, Las Vegas, Clark County, Nevada, 89146, United States

    LAS VEGAS, NV 891461126

    Phone: (702) 486-6000

    Fax: (702) 486-6248

    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 89146)

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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
PSYCHIATRYNV90833Psychotherapy, 30 minutes with patient and/or family member5113

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: 6608762547View full group profile

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1700991197 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Other Service Providers. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Las Vegas, Nevada. Check all listed addresses for suites or satellite offices.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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