Unknown Individual – Hematology & Oncology Physician, NPI 1104862879

Unknown Individual is a healthcare provider. based in Syracuse, New York. specializing in Hematology & Oncology Physician. They hold a License No. 161864 (NY). The NPI Number for Unknown Individual is 1104862879

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104862879
Phone
(315) 464-8200
Address
750 E ADAMS ST
Deactivation Date
27 November 2025

Doctor Profile

Medical School Name
STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
Secondary Phone
3152557393
Graduation Year
1979 (47 years ago)
PAC ID
0244142578
Group Practice PAC ID
2365346525
Professional Enrollment ID
I20080404000539
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

  • State University of New York Upstate Medical University, 750, East Adams Street, University Hill, Syracuse, Onondaga County, New York, 13210, United States

    REGIONAL ONCOLOGY CENTER

    SYRACUSE, NY 132102306

    Phone: (315) 464-8200

    Fax: (315) 464-8206

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes10127$0
99231Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes5021$0
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes1715$0
99221Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes1413$0
View full utilization report →

Insurance plans in this area (ZIP 13210)

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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: 2365346525View full group profile
NameSpecialtyState
Internal MedicineVA
Nurse PractitionerFL
Radiation OncologyNY
Radiation OncologyNY
Nephrology, Internal MedicineNY
-NY
Internal MedicineNY
Radiation OncologyMI
Physician AssistantNY
Internal MedicineNY

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1104862879; it appears in the national provider directory.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Hematology & Oncology Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Syracuse, New York for Unknown Individual based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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