Unknown Individual – Surgery Physician, NPI 1598812513

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Surgery Physician. They hold a License No. MT182037 (PA). The NPI Number for Unknown Individual is 1598812513

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1598812513
Phone
(503) 494-5501
Address
3181 SW SAM JACKSON PARK ROAD
Deactivation Date
17 January 2022

Doctor Profile

Medical School Name
STATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Secondary Phone
5034948311
Graduation Year
2003 (23 years ago)
PAC ID
1355535410
Group Practice PAC ID
4880760107
Professional Enrollment ID
I20180620003487
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience41
Completeness75
Years active:0State licenses:4Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Baird Hall, 3181, Southwest Sam Jackson Park Road, Marquam Hill, Homestead, Portland, Metro, Multnomah County, Oregon, 97239, United States

    MAIL CODE: L619

    PORTLAND, OR 97239

    Phone: (503) 494-5501

    Type: Mailing

  • OHSU Center For Health And Healing, 3303, Southwest Bond Avenue, South Portland, Portland, Metro, Multnomah County, Oregon, 97239, United States

    PORTLAND, OR 97239

    Phone: (503) 494-5501

    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 97239)

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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: 4880760107View full group profile

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 1598812513.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Surgery Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Portland, Oregon as the reference point for Unknown Individual, then confirm.
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.