Unknown Individual – Psychiatry Physician, NPI 1083701320

Unknown Individual is a healthcare provider. based in Salem, Oregon. specializing in Psychiatry Physician. They hold a License No. 10716 (OR). The NPI Number for Unknown Individual is 1083701320

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083701320
Phone
(503) 945-9840
Address
PO BOX 14900
Deactivation Date
6 November 2025

Doctor Profile

Medical School Name
CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5039472323
Graduation Year
1975 (51 years ago)
PAC ID
9234128976
Group Practice PAC ID
0547170383
Professional Enrollment ID
I20040508000232
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

  • PO BOX 14900

    SALEM, OR 973095016

    Phone: (503) 945-9840

    Type: Mailing

  • Oregon State Hospital, 2600, Center Street Northeast, Salem, Marion County, Oregon, 97301, United States

    SALEM, OR 97301

    Phone: (503) 945-2800

    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.

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.

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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 97309)

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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: 0547170383View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1083701320 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Salem?
Public fields place Unknown Individual around Salem, Oregon. Always confirm the exact site before visiting.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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