Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1013963776

Unknown Individual is a healthcare provider. based in Xenia, Ohio. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. 35-076489 (OH). The NPI Number for Unknown Individual is 1013963776

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013963776
Phone
(937) 376-8700
Address
452 W MARKET ST
Deactivation Date
14 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9373768700
Graduation Year
1992 (34 years ago)
PAC ID
7416046537
Group Practice PAC ID
8224011135
Professional Enrollment ID
I20071127000703
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 452, West Market Street, Waterstreet Historic District, Xenia, Greene County, Ohio, 45385, United States

    XENIA, OH 453852815

    Phone: (937) 376-8700

    Fax: (937) 376-8725

    Type: Mailing

  • Cincinnati Avenue, Waterstreet Historic District, Xenia, Greene County, Ohio, 45385, United States

    XENIA, OH 453855071

    Phone: (937) 376-8700

    Fax: (937) 376-8725

    Type: Location

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 45385)

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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: 8224011135View full group profile
NameSpecialtyState
P S Y C H I A T R YOH
Mental Health CounselorOH
Mental Health CounselorOH
Mental Health CounselorOH
Family PracticeOH
Clinical Social WorkerOH
P S Y C H I A T R YOH
Mental Health CounselorOH
Nurse PractitionerOH
Clinical Social WorkerOH

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1013963776.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Child & Adolescent Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Xenia, Ohio for Unknown Individual; download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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