Unknown Individual – Obstetrics & Gynecology Physician, NPI 1063404184

Unknown Individual is a healthcare provider. based in Chesapeake, Virginia. specializing in Obstetrics & Gynecology Physician. They hold a License No. 0101049160 (VA). The NPI Number for Unknown Individual is 1063404184

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063404184
Phone
(757) 548-3880
Address
300 MEDICAL PKWY
Deactivation Date
21 November 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7575483880
Graduation Year
1988 (38 years ago)
PAC ID
8921909748
Group Practice PAC ID
8820998156
Professional Enrollment ID
I20120319000036
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

  • Battlefield Medical Office Building, 300, Medical Parkway, Chesapeake, Virginia, 23320, United States

    SUITE 300

    CHESAPEAKE, VA 233204985

    Phone: (757) 548-3880

    Fax: (757) 548-3373

    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 8 Open Payments records for all available years, with a total value of $280.

Total Amount is formed as General ($280) + Research ($0) + Ownership ($0) = $280.

Last reported payment date: 2024-07-15 • Largest payer in this snapshot: Myriad Genetic Laboratories, Inc. ($103).

Total Amount

$280

General + Research + Ownership

Payments

8

Total payment records

General Amount

$280

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-07-15

Latest reported date

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
Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory2222$0
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination2020$0
99213Established patient office or other outpatient visit, 20-29 minutes1512$0
View full utilization report →

Insurance plans in this area (ZIP 23320)

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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: 8820998156View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YVA
Clinical Social WorkerVA
-VA
Nurse PractitionerVA
O B S T E T R I C S/ G Y N E C O L O G YVA
-VA
Nurse PractitionerVA
-VA
-VA
O B S T E T R I C S/ G Y N E C O L O G YVA

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1063404184.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
How should patients interpret Unknown Individual's specialty?
The extract shows Obstetrics & Gynecology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Chesapeake, Virginia?
For routing, start with Chesapeake, Virginia for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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Unknown Individual

Addiction Medicine (Internal Medicine) Physician
615 ELSINORE PL STE 200
NPI: 1346209830