Unknown Individual – Adult Health Nurse Practitioner, NPI 1629200191

Unknown Individual is a healthcare provider. based in Media, Pennsylvania. specializing in Adult Health Nurse Practitioner. They hold a License No. SP012188 (PA). The NPI Number for Unknown Individual is 1629200191

Main info

Organization
Inactive
18 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629200191
Phone
(610) 565-3300
Address
110 CHESLEY DR
Deactivation Date
11 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7247337544
Graduation Year
2008 (18 years ago)
PAC ID
6002099264
Group Practice PAC ID
8921234352
Professional Enrollment ID
I20140910002416
Data current as of
20 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

  • 110, Chesley Drive, Bowling Green, Nether Providence Township, Delaware County, Pennsylvania, 19063, United States

    MEDIA, PA 190631755

    Phone: (610) 565-3300

    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 19063)

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Provider's Procedures

Unknown Individual performs procedures in Adult Health Nurse Practitioner. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NURSE PRACTITIONERPA11101Biopsy of each additional growth of skin and/or tissue6658
NURSE PRACTITIONERPA17003Destruction of 2-14 skin growths1069188

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: 8921234352View full group profile
NameSpecialtyState
Physician AssistantPA
-FL
Nurse PractitionerPA
Nurse PractitionerTX
Nurse PractitionerPA
-PA
Nurse PractitionerPA
Nurse PractitionerPA

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1629200191 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Adult Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Media, Pennsylvania in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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