Unknown Individual – Orthopaedic Surgery Physician, NPI 1124051081

Unknown Individual is a healthcare provider. based in Gallipolis, Ohio. specializing in Orthopaedic Surgery Physician. They hold a License No. 3504832OH (OH). The NPI Number for Unknown Individual is 1124051081

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124051081
Phone
(740) 446-5000
Address
90 JACKSON PIKE
Deactivation Date
5 June 2024

Doctor Profile

Medical School Name
UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Secondary Phone
7403958420
Graduation Year
1981 (45 years ago)
PAC ID
2264322858
Group Practice PAC ID
5890606008
Professional Enrollment ID
I20040819001041

Contacts

Secure Messaging
edwin.hissa.1@17389.direct.athenahealth.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 90 JACKSON PIKE

    GALLIPOLIS, OH 456311560

    Phone: (740) 446-5000

    Fax: (740) 395-8855

    Type: Mailing

  • Holzer Medical Center - Jackson, 500, Burlington Road, Jackson, Jackson County, Ohio, 45640, United States

    JACKSON, OH 456409360

    Phone: (740) 395-8805

    Fax: (740) 395-8855

    Type: Mailing

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes7253$0
99203New patient office or other outpatient visit, 30-44 minutes2020$0
View full utilization report →

Insurance plans in this area (ZIP 45631)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ORTHOPEDIC SURGERYOH20610Aspiration and/or injection of large joint or joint capsule3215

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: 5890606008View full group profile

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1124051081 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Ohio?
You will see Gallipolis, Ohio on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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