Unknown Individual – Family Medicine Physician, NPI 1114962602

Unknown Individual is a healthcare provider. based in Sheffield village, Ohio. specializing in Family Medicine Physician. They hold a License No. 50500 (OH). The NPI Number for Unknown Individual is 1114962602

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114962602
Phone
(440) 934-0740
Address
5319 MEADOW LANE CT
Deactivation Date
12 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4409340740
Graduation Year
1972 (54 years ago)
PAC ID
2668495136
Professional Enrollment ID
I20060111000012
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

  • 5319, Meadow Lane Court, Sheffield, Lorain County, Ohio, 44035, United States

    SHEFFIELD VILLAGE, OH 440351469

    Phone: (440) 934-0740

    Fax: (440) 934-0740

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 44035)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1114962602 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Ohio is Unknown Individual registered?
Use Sheffield Village, Ohio as the headline location for Unknown Individual here.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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