Unknown Individual – Student in an Organized Health Care Education/Training Program, NPI 1780009597

Unknown Individual is a healthcare provider. based in Philadelphia, Pennsylvania. specializing in Student in an Organized Health Care Education/Training Program. The NPI Number for Unknown Individual is 1780009597

Main info

Organization
Inactive
12 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780009597
Phone
Not provided
Address
4190 CITY AVE
Deactivation Date
10 September 2021

Doctor Profile

Medical School Name
PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
6177546742
Graduation Year
2014 (12 years ago)
PAC ID
2860725280
Group Practice PAC ID
7719954981
Professional Enrollment ID
I20190617002582
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 4190 CITY AVE

    PHILADELPHIA, PA 191311626

    Phone:

    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 19131)

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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: 7719954981View full group profile
NameSpecialtyState
Orthopedic SurgeryWI
Orthopedic SurgeryNM
Orthopedic SurgeryOH
Orthopedic SurgeryIL
-MN
Orthopedic SurgeryHI
Orthopedic SurgeryWA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1780009597 in the public NPI dataset.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Student in an Organized Health Care Education/Training Program. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Philadelphia, Pennsylvania may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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