Unknown Individual – Family Medicine Physician, NPI 1417920422

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Springfield, Vermont. specializing in Family Medicine Physician. They hold a License No. 0420010212 (VT). The NPI Number for Unknown Individual is 1417920422

Main info

Organization

Inactive

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1417920422

Phone

(802) 886-8900

Address

PO BOX 710

Deactivation Date

11 August 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8024639000

Graduation Year

null (2026 years ago)

PAC ID

9234023342

Group Practice PAC ID

9133157043

Professional Enrollment ID

I20040210000896

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

710, Hatfield Point, Springfield Parish, New Brunswick, Canada
SPRINGFIELD, VT 051560710
Phone: (802) 886-8900
Type: Mailing
Springfield Health Center, 100, River Street, Springfield, Windsor County, Vermont, 05156, United States
SPRINGFIELD MEDICAL CARE SYSTEMS
SPRINGFIELD, VT 051562930
Phone: (802) 886-8900
Fax: (802) 886-8949
Type: Location

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 05156)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	VT	83036	Hemoglobin A1C level	22	13

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: 9133157043View full group profile

Name	Specialty	State
GARY A CLAY (MD)	-	VT
Unknown Individual	-	VT
DR. ADAM M AMEELE (PSY.D.)	Clinical Psychologist	VT
THOMAS OSBORN WANSLEBEN (PA-C)	-	NH
SANDRA MARY HOYTE (M.D.)	-	NC
JESSICA SUSAN WATERS DAVIS (MD)	Family Practice	NC
RICHARD A MARASA (MD)	-	NH
TIMOTHY ROWLAND (M.D.)	-	VT
BROOKE E PRINGLE (PAC)	-	VT
AUDREY LOHR (APRN, FNP-C)	Nurse Practitioner	VT