Unknown Individual – Psychiatry Physician, NPI 1205148053

Unknown Individual is a healthcare provider. based in Chillicothe, Ohio. specializing in Psychiatry Physician. They hold a License No. 011040 (OH). The NPI Number for Unknown Individual is 1205148053

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205148053
Phone
(740) 775-1260
Address
4449 STATE ROUTE 159
Deactivation Date
15 September 2021

Doctor Profile

Medical School Name
WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE
Secondary Phone
7407751260
Graduation Year
2010 (16 years ago)
PAC ID
1153755822
Group Practice PAC ID
7315832532
Professional Enrollment ID
I20200106001799
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 4449 STATE ROUTE 159

    CHILLICOTHE, OH 456018620

    Phone: (740) 775-1260

    Fax: (740) 773-8322

    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 45601)

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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: 7315832532View full group profile
NameSpecialtyState
Mental Health CounselorMI
Clinical Social WorkerOH
Nurse PractitionerOH
Mental Health CounselorOH
Clinical Social WorkerOH
Nurse PractitionerOH
Mental Health CounselorOH
Clinical PsychologistOH
Mental Health CounselorOH
Clinical Social WorkerOH

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1205148053.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Psychiatry Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Chillicothe, Ohio in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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