Unknown Individual – Family Medicine Physician, NPI 1104882661

Unknown Individual is a healthcare provider. based in Cincinnati, Ohio. specializing in Family Medicine Physician. They hold a License No. 35054707F (OH). The NPI Number for Unknown Individual is 1104882661

Main info

Organization
Inactive
42 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104882661
Phone
(513) 585-5507
Address
2830 VICTORY PARKWAY
Deactivation Date
11 March 2022

Doctor Profile

Medical School Name
UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Secondary Phone
5135848600
Graduation Year
1984 (42 years ago)
PAC ID
5991872723
Group Practice PAC ID
2264344480
Professional Enrollment ID
I20080922000072
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

  • 2830, Victory Parkway, East Walnut Hills, Cincinnati, Hamilton County, Ohio, 45206, United States

    PAYOR ENROLLMENT

    CINCINNATI, OH 452061785

    Phone: (513) 585-5507

    Type: Mailing

  • 3120, Burnet Avenue, Pill Hill, Corryville, Cincinnati, Hamilton County, Ohio, 45229, United States

    CINCINNATI, OH 452293091

    Phone: (513) 584-8600

    Fax: (513) 584-8619

    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 45206)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEOH81002Urinalysis, manual test2725

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: 2264344480View full group profile
NameSpecialtyState
Unknown Individual
-OH
DR. RALPH VATNER (M.D., PH.D.)
Radiation OncologyOH
JAMES MATTHEW GRAU
Certified Registered Nurse Anesthetist (Crna)OH
JOHN DEAN ADLER (MD)
-OH
ALBERTO ESPAY (MD)
N E U R O L O G YOH
NITA WALKER (M.D.)
-OH
JAMES W BUCKREUS (M.D.)
-OH
DR. LISA W JASON (MD)
-OH
ROBERT PULLIAM (MD)
-OH
MELISSA G ERICKSON (MD)
Family PracticeOH

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1104882661 on file in the registry.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Family Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Where in Ohio is Unknown Individual registered?
Use Cincinnati, Ohio as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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