Unknown Individual – Otolaryngology Physician, NPI 1508835679

Unknown Individual is a healthcare provider. based in Johnson city, Tennessee. specializing in Otolaryngology Physician. They hold a License No. 10901 (TN). The NPI Number for Unknown Individual is 1508835679

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1508835679
Phone
(423) 929-9101
Address
2340 KNOB CREEK RD 704
Deactivation Date
11 October 2024

Doctor Profile

Medical School Name
UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Secondary Phone
4239299101
Graduation Year
1976 (50 years ago)
PAC ID
9032154398
Group Practice PAC ID
0244266344
Professional Enrollment ID
I20050627001028
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

  • 704, Knob Creek Road, West Hills, Johnson City, Washington County, Tennessee, 37604, United States

    JOHNSON CITY, TN 376042977

    Phone: (423) 929-9101

    Type: Location

  • 117, Ridgemont Road, Tanglewood, Bel Air One, Johnson City, Washington County, East Tennessee, Tennessee, 37601, United States

    JOHNSON CITY, TN 376014629

    Phone: (423) 929-9101

    Fax: (423) 434-2032

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 3 Open Payments records for all available years, with a total value of $70.

Total Amount is formed as General ($70) + Research ($0) + Ownership ($0) = $70.

Last reported payment date: 2024-03-28 • Largest payer in this snapshot: Masimo Corporation ($36).

Total Amount

$70

General + Research + Ownership

Payments

3

Total payment records

General Amount

$70

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-28

Latest reported date

Top Companies

Largest payers in this snapshot

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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 37604)

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Provider's Procedures

Unknown Individual performs procedures in Otolaryngology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OTOLARYNGOLOGYTN92540Observation, testing, and recording of abnormal eye movement1616
OTOLARYNGOLOGYTN92567Eardrum testing using ear probe211189

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: 0244266344View full group profile
NameSpecialtyState
-TN
Physician AssistantTN
Qualified AudiologistVA
O T O L A R Y N G O L O G YTN
Qualified AudiologistTN
Physician AssistantTN
O T O L A R Y N G O L O G YWI
Otolaryngology, Allergy/ImmunologyTN
Physician AssistantTN
O T O L A R Y N G O L O G YIA

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1508835679 if you need a stable reference for Unknown Individual.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Otolaryngology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Tennessee?
You will see Johnson City, Tennessee on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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