Unknown Individual – Orthopaedic Surgery Physician, NPI 1417120445

Orthopaedic Surgery Physician

Unknown Individual is a healthcare provider. based in Medford, Oregon. specializing in Orthopaedic Surgery Physician. They hold a License No. MD166336 (OR). The NPI Number for Unknown Individual is 1417120445

Main info

Organization

Inactive

18 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417120445

Phone

(541) 789-4281

Address

2620 EAST BARNETT RD, SUITE H

Deactivation Date

3 July 2024

Doctor Profile

Medical School Name

SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

5415072170

Graduation Year

2008 (18 years ago)

PAC ID

5799912770

Group Practice PAC ID

8325206246

Professional Enrollment ID

I20140807000327

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience24

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

2620 EAST BARNETT RD, SUITE H
MEDFORD, OR 975048283
Phone: (541) 789-4281
Fax: (541) 789-5538
Type: Mailing
625, Ramsey Avenue, Grants Pass, Josephine County, Oregon, 97527, United States
SUITE A
GRANTS PASS, OR 975275805
Phone: (541) 789-5250
Fax: (541) 789-5530
Type: Location
2780 E BARNETT RD STE 200
MEDFORD, OR 975048674
Phone: (541) 779-6250
Fax: (541) 608-2535
Type: Mailing
702 SW RAMSEY AVE STE 112
GRANTS PASS, OR 975275859
Phone: (541) 472-0603
Fax: (541) 472-0609
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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
J0775	Injection, collagenase, clostridium histolyticum, 0.01 mg	2,250	21	$0
J3301	Injection, triamcinolone acetonide, not otherwise specified, 10 mg	500	114	$0
99213	Established patient office or other outpatient visit, 20-29 minutes	131	119	$0
73130	X-ray of hand, minimum of 3 views	120	91	$0
99214	Established patient office or other outpatient visit, 30-39 minutes	119	112	$0

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Insurance plans in this area (ZIP 97504)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
ORTHOPEDIC SURGERY	OR	73110	X-ray of wrist, minimum of 3 views	70	43
ORTHOPEDIC SURGERY	OR	73140	X-ray of fingers, minimum of 2 views	25	23

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: 8325206246View full group profile

Name	Specialty	State
DR. MICHAEL J. BACHOP (PH.D.)	-	OR
PETER G TEICHMAN (MD)	-	WV
DR. JEFFREY C WAGNER (M.D.)	N E U R O L O G Y	CO
CHRISTIAN JAMES WAYNE BURRELL	N E U R O L O G Y	FL
BRETT M WILLIAMS (FNP)	Nurse Practitioner	OR
OSCAR ADOLFO SANCHEZ (MD)	N E U R O L O G Y	OR
Unknown Individual	-	OR
KATHRYN HARDAWAY (NP-C)	Nurse Practitioner	GA
DR. ALEXANDER ERINO BONATO (MD)	Internal Medicine	OR
NATHAN HSIANG-EN KUNG (MD)	N E U R O L O G Y	CO