Unknown Individual – Emergency Medicine Physician, NPI 1023074812

Emergency Medicine Physician

Unknown Individual is a healthcare provider. based in Portsmouth, Virginia. specializing in Emergency Medicine Physician. They hold a License No. 0101033150 (VA). The NPI Number for Unknown Individual is 1023074812

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1023074812

Phone

(757) 686-3508

Address

PO BOX 7068

Deactivation Date

13 March 2025

Doctor Profile

Medical School Name

JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY

Secondary Phone

7574244442

Graduation Year

1979 (47 years ago)

PAC ID

8820997554

Group Practice PAC ID

5597664201

Professional Enrollment ID

I20090326000688

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

Portsmouth Post Office, Heritage Avenue, Maplehaven, Portsmouth, Rockingham County, New Hampshire, 03801, United States
PORTSMOUTH, VA 237070068
Phone: (757) 686-3508
Fax: (757) 686-0541
Type: Mailing
6632, Indian River Road, Virginia Beach, Virginia, 23464, United States
VIRGINIA BEACH, VA 234643442
Phone: (757) 424-4300
Fax: (757) 523-0632
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $30.

Total Amount is formed as General ($30) + Research ($0) + Ownership ($0) = $30.

Last reported payment date: 2024-05-02 • Largest payer in this snapshot: PFIZER INC. ($30).

Total Amount

$30

General + Research + Ownership

Payments

Total payment records

General Amount

$30

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2024-05-02

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
PFIZER INC.	$30

View all Open Payments →|Open Payments Risk Radar →

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
G0008	Administration of influenza virus vaccine	12	12	$0

View full utilization report →

Insurance plans in this area (ZIP 23707)

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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: 5597664201View full group profile

Name	Specialty	State
ARUNAVA PAUL (MD)	Nephrology, Hospitalist, Internal Medicine	VA
PALAK KACHHADIA (MD)	E N D O C R I N O L O G Y	VA
DR. JIEMING YAN (MD)	Internal Medicine	VA
VERA GOODE (MD)	Internal Medicine	VA
MS. BEVERLY EVERITT (APRN)	-	NE
JEANNINE M LEADBEATER (MD)	-	VA
DR. DAVID HOWELL LASSETER (MD)	Endocrinology, Internal Medicine	VA
SAJUMA BHAJU (MD)	Hospitalist, Family Practice	VA
DR. KARIN MARIA SANDVED (MD)	-	VA
DIANA L WOLAN (MD)	-	VA