Unknown Individual – Family Medicine Physician, NPI 1720021413

Unknown Individual is a healthcare provider. based in Columbus, Ohio. specializing in Family Medicine Physician. They hold a License No. 35050342 (OH). The NPI Number for Unknown Individual is 1720021413

Main info

Organization
Inactive
60 Years Of Experience
Name
Unknown Individual
NPI
1720021413
Phone
(614) 252-0917
Address
1289 E LIVINGSTON AVE
Deactivation Date
12 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6144445340
Graduation Year
1966 (60 years ago)
PAC ID
3870787542
Group Practice PAC ID
9032434295
Professional Enrollment ID
I20101027000736
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

  • 1289, East Livingston Avenue, South-of-Main, Columbus, Franklin, Ohio, 43205, United States

    COLUMBUS, OH 432052838

    Phone: (614) 252-0917

    Fax: (614) 252-6153

    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 43205)

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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: 9032434295View full group profile
NameSpecialtyState
DR. AJAY P SYAM (D.C., CICE)
-OH
RYAN SAYLOR (DPT)
-OH

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1720021413 on file in the registry.
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 Family Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Columbus?
Public fields place Unknown Individual around Columbus, Ohio. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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