Unknown Individual – Dermatology Physician, NPI 1639175441

Unknown Individual is a healthcare provider. based in Albuquerque, New Mexico. specializing in Dermatology Physician. They hold a License No. 99-316 (NM). The NPI Number for Unknown Individual is 1639175441

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639175441
Phone
(505) 262-7097
Address
12213 CAMELOT PL NE
Deactivation Date
15 May 2025

Doctor Profile

Medical School Name
UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
Secondary Phone
5052437546
Graduation Year
1989 (37 years ago)
PAC ID
5890703375
Group Practice PAC ID
9234238775
Professional Enrollment ID
I20060324000154
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

  • 12213, Camelot Place Northeast, North Albuquerque Acres, Bernalillo County, New Mexico, 87122, United States

    ALBUQUERQUE, NM 871224320

    Phone: (505) 262-7097

    Fax: (505) 262-7636

    Type: Mailing

  • 6200, Uptown Boulevard Northeast, Uptown, Albuquerque, Bernalillo County, New Mexico, 87110, United States

    SUITE 410

    ALBUQUERQUE, NM 871104159

    Phone: (505) 243-7546

    Fax: (505) 243-7547

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 36 Open Payments records for all available years, with a total value of $813.

Total Amount is formed as General ($813) + Research ($0) + Ownership ($0) = $813.

Last reported payment date: 2024-12-11 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($258).

Total Amount

$813

General + Research + Ownership

Payments

36

Total payment records

General Amount

$813

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-11

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
17003Destruction of precancer skin growth, 2-14 growths2,704476$0
17000Destruction of precancer skin growth, 1 growth856608$0
99214Established patient office or other outpatient visit, 30-39 minutes848646$0
99213Established patient office or other outpatient visit, 20-29 minutes513435$0
17110Destruction of skin growth, 1-14 growths262237$0
View full utilization report →

Insurance plans in this area (ZIP 87122)

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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: 9234238775View full group profile
NameSpecialtyState
Dermatology, Family PracticeNM
D E R M A T O L O G YNM
D E R M A T O L O G YNM
Dermatology, Micrographic Dermatologic Surgery (Mds)NM
Physician AssistantNM
D E R M A T O L O G YNM
Physician AssistantNM
Physician AssistantNM

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1639175441 in the public NPI dataset.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Dermatology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Albuquerque, New Mexico may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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