Unknown Individual – Diagnostic Radiology Physician, NPI 1639140882

Unknown Individual is a healthcare provider. based in Sewickley, Pennsylvania. specializing in DIAGNOSTIC RADIOLOGY. They hold a License No. MD020903E (PA). The NPI Number for Unknown Individual is 1639140882

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1639140882
Phone
(412) 741-5717
Address
304 CHAUCER CT N
Deactivation Date
7 May 2026

Doctor Profile

Medical School Name
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
Secondary Phone
8783133338
Graduation Year
1977 (49 years ago)
PAC ID
8729076138
Group Practice PAC ID
4880648351
Professional Enrollment ID
I20050210000260
Address ID
PA150092998BE500XXSTXX301
Data current as of
3 June 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

2,576 DIAGNOSTIC RADIOLOGY in PA

Provider Addresses for Unknown Individual

  • 304 CHAUCER CT N

    SEWICKLEY, PA 151438728

    Phone: (412) 741-5717

    Fax: (412) 741-6973

    Type: Mailing

  • 11995 SINGLETREE LN STE 500

    EDEN PRAIRIE, MN 553445349

    Phone: (952) 595-1301

    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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-10-03

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20050210000260IDiagnostic RadiologyPATBD
I20161003000782IDiagnostic RadiologyTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
71046X-ray of chest, 2 views8579$0
93971Ultrasound study of one arm or leg veins with compression and maneuvers5950$0
73630X-ray of foot, minimum of 3 views4435$0
76536Ultrasound scan of head and neck soft tissue2929$0
73502X-ray of hip, 2-3 views2828$0
View full utilization report →

Insurance plans in this area (ZIP 15143)

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Provider's Procedures

Unknown Individual performs procedures in DIAGNOSTIC RADIOLOGY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYPA71010X-ray of chest, 1 view, front325255
DIAGNOSTIC RADIOLOGYPA73630X-ray of foot, minimum of 3 views2522

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: 4880648351View full group profile
NameSpecialtyState
P O D I A T R YPA
P O D I A T R YPA
General SurgeryPA

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1639140882 on file in the registry.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Sewickley?
Public fields place Unknown Individual around Sewickley, Pennsylvania. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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