Unknown Individual – Family Medicine Physician, NPI 1477638690

Unknown Individual is a healthcare provider. based in Pawtucket, Rhode Island. specializing in Family Medicine Physician. They hold a License No. MD03860 (RI). The NPI Number for Unknown Individual is 1477638690

Main info

Organization
Inactive
67 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477638690
Phone
(401) 725-4100
Address
209 ARMISTICE BLVD
Deactivation Date
12 February 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4017254100
Graduation Year
1959 (67 years ago)
PAC ID
8022202233
Group Practice PAC ID
0941266415
Professional Enrollment ID
I20101102000377
Data current as of
19 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

  • 209, Armistice Boulevard, Darlington, Pawtucket, Providence County, Rhode Island, 02860, United States

    PAWTUCKET HEALTHCARE INC

    PAWTUCKET, RI 02860

    Phone: (401) 725-4100

    Fax: (401) 728-5010

    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 02860)

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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: 0941266415View full group profile
NameSpecialtyState
Physician AssistantRI
Family PracticeRI
Nurse PractitionerRI
U R O L O G YRI
Nurse PractitionerRI
Nurse PractitionerRI
Nurse PractitionerRI
-RI
Physician AssistantRI

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1477638690 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Pawtucket, Rhode Island for Unknown Individual; expand the address list for detail.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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