Unknown Individual – Physician Assistant, NPI 1124094396

Unknown Individual is a healthcare provider. based in Rochester, New York. specializing in Physician Assistant. They hold a License No. 5404 (NY). The NPI Number for Unknown Individual is 1124094396

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124094396
Phone
(585) 275-5321
Address
601 ELMWOOD AVE
Deactivation Date
9 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5852755321
Graduation Year
1995 (31 years ago)
PAC ID
9436285814
Group Practice PAC ID
7012909161
Professional Enrollment ID
I20100325000371

Contacts

Secure Messaging
mneracker48714@direct.urmc.rochester.edu
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

Loading map...

Provider Addresses for Unknown Individual

  • University of Rochester Medical Center, 601, Elmwood Avenue, Upper Mount Hope, Rochester, Monroe, New York, 14611, United States

    BOX 665

    ROCHESTER, NY 146420001

    Phone: (585) 275-5321

    Fax: (585) 756-4721

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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
99213Established patient office or other outpatient visit, 20-29 minutes7367$0
J1030Injection, methylprednisolone acetate, 40 mg5734$0
20610Aspiration and/or injection of fluid from large joint5443$0
View full utilization report →

Insurance plans in this area (ZIP 14642)

Loading plans...

Provider's Procedures

Unknown Individual performs procedures in Physician Assistant. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICIAN ASSISTANTNY20610Aspiration and/or injection of large joint or joint capsule5857

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: 7012909161View full group profile
NameSpecialtyState
Orthopedic SurgeryNY
Orthopedic SurgeryNY
-NY
Physician AssistantNY
Orthopedic Surgery, Sports MedicineNY
Physician AssistantNY
-NY
Physician AssistantNY
Orthopedic Surgery, Sports MedicineNY
Physician AssistantNY

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1124094396.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Physician Assistant. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Rochester, New York in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

Similar Providers

CHERYL A PARNELL (PA)

Physician Assistant
360 LINDEN OAKS DR
NPI: 1770585085

STEVEN M FINE (MD)

Infectious Disease Physician
777, South Clinton Avenue, Washington Square, Rochester, Monroe, New York, 14620, United States
NPI: 1780682351

DR. PAUL FRANCES SCHEIB (PA)

Physician Assistant
PO BOX 8000
NPI: 1073513651

MR. BRIAN D ADCOCK (PA)

Physician Assistant
PO BOX 1213
NPI: 1194725788

JAMES A KRESGE (RPAC)

Procedural Dermatology Physician
30, North Union Street, East End, Rochester, Monroe, New York, 14607, United States
NPI: 1073515839

MS. MARIA A DEROSA (RPAC)

Physician Assistant
30, North Union Street, East End, Rochester, Monroe, New York, 14607, United States
NPI: 1740282508
5901 LAC DE VILLE BLVD
NPI: 1568454437

MRS. CRYSTAL L ENGLERT (PA)

Physician Assistant
730, Weiland Road, City of Rochester, Monroe County, New York, 14626, United States
NPI: 1609861533
1425 Portland Ave
NPI: 1942290184