Unknown Individual – Dermatology Physician, NPI 1124007992

Unknown Individual is a healthcare provider. based in Zanesville, Ohio. specializing in Dermatology Physician. They hold a License No. 34-00-4301-H (OH). The NPI Number for Unknown Individual is 1124007992

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124007992
Phone
(740) 454-7546
Address
930 BETHESDA DR
Deactivation Date
17 July 2024

Doctor Profile

Medical School Name
WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
Secondary Phone
6148474100
Graduation Year
1979 (47 years ago)
PAC ID
8325943442
Group Practice PAC ID
9739087602
Professional Enrollment ID
I20031205000133
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

  • 930, Bethesda Drive, Zanesville, Muskingum County, Ohio, 43701, United States

    BLDG 4

    ZANESVILLE, OH 437010815

    Phone: (740) 454-7546

    Fax: (740) 454-6760

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $19.

Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.

Last reported payment date: 2023-03-21 • Largest payer in this snapshot: ABBVIE INC. ($19).

Total Amount

$19

General + Research + Ownership

Payments

1

Total payment records

General Amount

$19

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-21

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$19
View all Open Payments →|Open Payments Risk Radar →

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 43701)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYOH11101Biopsy of each additional growth of skin and/or tissue13280

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: 9739087602View full group profile
NameSpecialtyState
Physician AssistantOH
D E R M A T O L O G YOH
P A T H O L O G YOH
Physician AssistantOH
D E R M A T O L O G YOH
D E R M A T O L O G YOH
D E R M A T O L O G YOH
D E R M A T O L O G YOH
Dermatology, Micrographic Dermatologic Surgery (Mds)OH
Dermatology, PathologyOH

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1124007992 in the public NPI dataset.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Dermatology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Zanesville, Ohio as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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