Unknown Individual – Orthopaedic Surgery Physician, NPI 1407997273

Unknown Individual is a healthcare provider. based in Bountiful, Utah. specializing in Orthopaedic Surgery Physician. They hold a License No. 321929-1205 (UT). The NPI Number for Unknown Individual is 1407997273

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1407997273
Phone
(801) 295-7200
Address
1551 RENAISSANCE TOWNE DR
Deactivation Date
1 November 2023

Doctor Profile

Medical School Name
ST. LOUIS COLLEGE OF PHYSICIANS AND SURGEONS
Secondary Phone
-
Graduation Year
1991 (35 years ago)
PAC ID
5092770461
Professional Enrollment ID
I20041124000500
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

  • Renaissance Towne Drive, Renaissance Towne Center, Bountiful, Davis County, Utah, 84010, United States

    STE. 400

    BOUNTIFUL, UT 840107667

    Phone: (801) 295-7200

    Fax: (801) 295-4930

    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 84010)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ORTHOPEDIC SURGERYUT20610Aspiration and/or injection of large joint or joint capsule8635
ORTHOPEDIC SURGERYUT73562X-ray of knee, 3 views1917

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1407997273.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Bountiful, Utah for Unknown Individual based on available NPPES addresses.
What if Bountiful, Utah seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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