Unknown Individual – Clinical Social Worker, NPI 1245420421

Unknown Individual is a healthcare provider. based in Klamath falls, Oregon. specializing in Clinical Social Worker. They hold a License No. L4979 (OR). The NPI Number for Unknown Individual is 1245420421

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1245420421
Phone
(541) 274-6733
Address
2801 Daggett Ave
Deactivation Date
31 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5412746221
Graduation Year
1982 (44 years ago)
PAC ID
9234108861
Group Practice PAC ID
1052204096
Professional Enrollment ID
I20180321001519
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2801 Daggett Ave

    Klamath Falls, OR 976017150

    Phone: (541) 274-6733

    Type: Location

  • Daggett Avenue, Klamath Falls, Klamath County, Oregon, 97601, United States

    KLAMATH FALLS, OR 976011106

    Phone: (541) 274-6733

    Fax: (541) 274-2006

    Type: Location

  • Sky Lakes Medical Center, 2865, Daggett Avenue, Klamath Falls, Klamath County, Oregon, 97601, United States

    KLAMATH FALLS, OR 976011106

    Phone: (541) 274-6564

    Fax: (541) 274-6247

    Type: Mailing

  • 330 Crampton St

    Reno, NV 895022480

    Phone: (775) 336-3700

    Fax: (775) 336-3701

    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.

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 97601)

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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: 1052204096View full group profile
NameSpecialtyState
RYAN DUTTON (PA-C)
Physician AssistantOR
DWIGHT W SMITH (MD)
Family PracticeOR
SHARON K HEATON (F.N.P.)
Nurse PractitionerOR
BEVERLY H. BAUMAN (MD)
-OR
DR. CHARLES KEITH COFAS (M.D.)
Internal MedicineOR
RADU MOISA (M.D.)
Family PracticeOR
RYAN BRENT UDINK (D.O.)
-OR
EDWARD L VAN TASSEL (DO)
-OR
TONYA DITRAPANI STEPHENSON (MD)
Neurology, NeuropsychiatryFL
MR. JEFFREY WILLIAM CHUDOBA (MD)
Diagnostic RadiologyOR

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1245420421 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Klamath Falls, Oregon for Unknown Individual based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.