Unknown Individual – Clinical Social Worker, NPI 1043512650

Unknown Individual is a healthcare provider. based in Salt lake city, Utah. specializing in Clinical Social Worker. They hold a License No. 5239017-3501 (UT). The NPI Number for Unknown Individual is 1043512650

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043512650
Phone
(888) 949-4864
Address
4460 S HIGHLAND DR
Deactivation Date
13 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8012736402
Graduation Year
2001 (25 years ago)
PAC ID
1052679123
Group Practice PAC ID
0042121196
Professional Enrollment ID
I20171219000217
Data current as of
20 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

  • 4460 S HIGHLAND DR

    SALT LAKE CITY, UT 841243543

    Phone: (888) 949-4864

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90791Psychiatric diagnostic evaluation6260$0
90837Psychotherapy, 1 hour4912$0
View full utilization report →

Insurance plans in this area (ZIP 84124)

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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: 0042121196View full group profile

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1043512650 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Clinical Social Worker in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Salt Lake City?
Unknown Individual currently maps to Salt Lake City, Utah in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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