Unknown Individual – Internal Medicine Physician, NPI 1124080148

Unknown Individual is a healthcare provider. based in Glen allen, Virginia. specializing in Internal Medicine Physician. They hold a License No. D0054903 (MD). The NPI Number for Unknown Individual is 1124080148

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124080148
Phone
(804) 968-5700
Address
5000 COX RD
Deactivation Date
12 November 2020

Doctor Profile

Medical School Name
UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Secondary Phone
2404271926
Graduation Year
1988 (38 years ago)
PAC ID
7810905999
Group Practice PAC ID
4385538735
Professional Enrollment ID
I20060331000111
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

  • 5000 COX RD

    GLEN ALLEN, VA 230609263

    Phone: (804) 968-5700

    Type: Mailing

  • Patient First, 5900, Cedar Lane, Cedar Woods, Hickory Ridge, Columbia, Howard County, Maryland, 21044, United States

    COLUMBIA, MD 210443635

    Phone: (443) 718-4067

    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 23060)

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Provider's Procedures

Unknown Individual performs procedures in Internal Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEMD83036Hemoglobin A1C level295155
INTERNAL MEDICINEMD90670Pneumococcal vaccine for injection into muscle4645

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: 4385538735View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1124080148.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Internal Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Glen Allen, Virginia in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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