Unknown Individual – Emergency Medicine Physician, NPI 1295762615

Unknown Individual is a healthcare provider. based in Cincinnati, Ohio. specializing in Emergency Medicine Physician. They hold a License No. 627 (TN). The NPI Number for Unknown Individual is 1295762615

Main info

Organization
Inactive
45 Years Of Experience
Name
Unknown Individual
NPI
1295762615
Phone
Not provided
Address
PO BOX 636019
Deactivation Date
9 November 2021

Doctor Profile

Medical School Name
AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Secondary Phone
7068588083
Graduation Year
1981 (45 years ago)
PAC ID
1557312493
Group Practice PAC ID
0840284659
Professional Enrollment ID
I20151208000821

Contacts

Secure Messaging
restorationrecoveryclinics@restoration-recovery.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • PO BOX 636019

    CINCINNATI, OH 452636019

    Phone:

    Type: Mailing

  • 2130 Chambliss Ave NW

    Cleveland, TN 373113839

    Phone: (423) 498-2000

    Fax: (423) 498-2001

    Type: Location

  • 1500 Dug Gap Rd

    Dalton, GA 307205009

    Phone: (423) 498-2000

    Fax: (423) 498-2001

    Type: Location

  • Cumberland Medical Center, 421, South Main Street, Grassland Addition, Crossville, Cumberland County, Tennessee, 38555, United States

    CROSSVILLE, TN 385555048

    Phone: (931) 484-9511

    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.

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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 45263)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1295762615?
NPI 1295762615 belongs to Unknown Individual; compare other details if you need extra assurance.
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 Emergency Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Cincinnati?
Unknown Individual currently maps to Cincinnati, Ohio in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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