Unknown Individual – Family Medicine Physician, NPI 1285629287

Unknown Individual is a healthcare provider. based in Waynesboro, Tennessee. specializing in Family Medicine Physician. They hold a License No. 25882 (TN). The NPI Number for Unknown Individual is 1285629287

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1285629287
Phone
(931) 722-2800
Address
PO BOX 689
Deactivation Date
4 December 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9317222800
Graduation Year
1993 (33 years ago)
PAC ID
1850293432
Group Practice PAC ID
1153223730
Professional Enrollment ID
I20040505001670
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

Provider Addresses for Unknown Individual

  • PO BOX 689

    WAYNESBORO, TN 384850689

    Phone: (931) 722-2800

    Fax: (931) 722-9627

    Type: Mailing

  • 107 JV MANGUBAT DR

    WAYNESBORO, TN 384852440

    Phone: (931) 722-2800

    Fax: (931) 722-9627

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $26.

Total Amount is formed as General ($26) + Research ($0) + Ownership ($0) = $26.

Last reported payment date: 2024-08-27 • Largest payer in this snapshot: ABBVIE INC. ($26).

Total Amount

$26

General + Research + Ownership

Payments

1

Total payment records

General Amount

$26

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-27

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$26
View all Open Payments →|Open Payments Risk Radar →

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 38485)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
EMERGENCY MEDICINETN95117Injection of incremental dosages of allergen, 2 or more injections20520

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1285629287 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Waynesboro?
Unknown Individual currently maps to Waynesboro, Tennessee in this extract.
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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