Unknown Individual – Dermatology Physician, NPI 1972697654

Unknown Individual is a healthcare provider. based in Hendersonville, Tennessee. specializing in Dermatology Physician. They hold a License No. 35-098352 (OH). The NPI Number for Unknown Individual is 1972697654

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1972697654
Phone
(615) 266-3376
Address
105 MAPLE ROW BLVD
Deactivation Date
13 May 2021

Doctor Profile

Medical School Name
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
6152663376
Graduation Year
2004 (22 years ago)
PAC ID
4284783440
Group Practice PAC ID
7416298104
Professional Enrollment ID
I20190405001959
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 105, Maple Row Boulevard, Hendersonville, Sumner County, Tennessee, 37075, United States

    HENDERSONVILLE, TN 370753853

    Phone: (615) 266-3376

    Fax: (484) 918-8506

    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 37075)

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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: 7416298104View full group profile
NameSpecialtyState
Physician AssistantIA
Physician AssistantTN
Micrographic Dermatologic Surgery (Mds), DermatologyTN

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1972697654.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Dermatology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Hendersonville, Tennessee may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.