Unknown Individual – Psychiatry Physician, NPI 1053306472

Unknown Individual is a healthcare provider. based in Charlottesville, Virginia. specializing in Psychiatry Physician. They hold a License No. 0101025436 (VA). The NPI Number for Unknown Individual is 1053306472

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053306472
Phone
(434) 296-9740
Address
175 S PANTOPS DR STE 205
Deactivation Date
8 January 2026

Doctor Profile

Medical School Name
UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
Secondary Phone
-
Graduation Year
1976 (50 years ago)
PAC ID
1355387184
Professional Enrollment ID
I20050701000714
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

Provider Addresses for Unknown Individual

  • 175 S PANTOPS DR STE 205

    CHARLOTTESVILLE, VA 229118673

    Phone: (434) 296-9740

    Fax: (434) 284-8923

    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)

CMS reports 4 Open Payments records for all available years, with a total value of $126.

Total Amount is formed as General ($126) + Research ($0) + Ownership ($0) = $126.

Last reported payment date: 2023-10-23 • Largest payer in this snapshot: ABBVIE INC. ($104).

Total Amount

$126

General + Research + Ownership

Payments

4

Total payment records

General Amount

$126

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-10-23

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$104
Corium, LLC$23
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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes25954$0
90833Psychotherapy with evaluation and management visit, 30 minutes16748$0
90836Psychotherapy with evaluation and management visit, 45 minutes9224$0
View full utilization report →

Insurance plans in this area (ZIP 22911)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYVA90833Psychotherapy, 30 minutes with patient and/or family member6838

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 1053306472.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Psychiatry Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Charlottesville, Virginia may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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