Unknown Individual – Clinical Psychologist, NPI 1922028927

Unknown Individual is a healthcare provider. based in Yellow springs, Ohio. specializing in Clinical Psychologist. They hold a License No. 3006 (OH). The NPI Number for Unknown Individual is 1922028927

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1922028927
Phone
(937) 767-9171
Address
416 XENIA AVE
Deactivation Date
18 January 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9377679171
Graduation Year
1979 (47 years ago)
PAC ID
6709862550
Group Practice PAC ID
0749266591
Professional Enrollment ID
I20060213000067
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

  • 416, Xenia Avenue, Yellow Springs Historic District, Yellow Springs, Greene County, Ohio, 45387, United States

    YELLOW SPRINGS, OH 453871836

    Phone: (937) 767-9171

    Fax: (937) 767-9175

    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 45387)

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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: 0749266591View full group profile
NameSpecialtyState
Mental Health CounselorOH
-OH
Clinical Social WorkerOH
Clinical Social WorkerOH
Clinical Social WorkerOH
Mental Health CounselorOH
Clinical PsychologistOH
Mental Health CounselorWA
Mental Health CounselorOH
Clinical PsychologistKY

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 1922028927.
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.
How should patients interpret Unknown Individual's specialty?
The extract shows Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Yellow Springs, Ohio. Check all listed addresses for suites or satellite offices.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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