Unknown Individual – Family Medicine Physician, NPI 1215904024

Unknown Individual is a healthcare provider. based in Springfield, Oregon. specializing in Family Medicine Physician. They hold a License No. MD9957 (OR). The NPI Number for Unknown Individual is 1215904024

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215904024
Phone
(541) 747-4300
Address
2280 MARCOLA ROAD
Deactivation Date
22 April 2021

Doctor Profile

Medical School Name
NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Secondary Phone
5417474300
Graduation Year
1971 (55 years ago)
PAC ID
7810956166
Group Practice PAC ID
0042100372
Professional Enrollment ID
I20041004000694
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

  • 2280, Marcola Road, Springfield, Lane County, Oregon, 97477, United States

    SPRINGFIELD, OR 974772594

    Phone: (541) 747-4300

    Fax: (541) 747-0655

    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 97477)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEOR81002Urinalysis, manual test2116
FAMILY MEDICINEOR90670Pneumococcal vaccine for injection into muscle3535

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: 0042100372View full group profile
NameSpecialtyState
Physician AssistantOR
-OR
Clinical PsychologistOR
Preventive MedicineOR
Family PracticeFL
Family PracticeOR
Family PracticeOR
Nurse PractitionerOR
Family PracticeTX
Physician AssistantOR

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1215904024.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where in Oregon is Unknown Individual registered?
Use Springfield, Oregon as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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Unknown Individual

Family Medicine Physician
Harlow Road, Springfield, Lane County, Oregon, 97475, United States
NPI: 1457339947