Unknown Individual – Physician Assistant, NPI 1225120967

Unknown Individual is a healthcare provider. based in Midlothian, Virginia. specializing in Physician Assistant. They hold a License No. 0110002759 (VA). The NPI Number for Unknown Individual is 1225120967

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1225120967
Phone
(804) 794-9148
Address
15124 WATERMILL LAKE TRL
Deactivation Date
7 February 2024

Doctor Profile

Medical School Name
UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
Secondary Phone
8044950053
Graduation Year
2005 (21 years ago)
PAC ID
4880647072
Group Practice PAC ID
5294960696
Professional Enrollment ID
I20200309001523
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 15124 WATERMILL LAKE TRL

    MIDLOTHIAN, VA 231124238

    Phone: (804) 794-9148

    Type: Mailing

  • 7200 Glen Forest Dr Ste 106

    Richmond, VA 232263768

    Phone: (804) 495-0053

    Fax: (720) 598-0440

    Type: Location

  • Hunter Holmes McGuire Veterans Administration Medical Center, 1201, Broad Rock Boulevard, Richmond, Richmond City, Virginia, 23249, United States

    RICHMOND, VA 232490001

    Phone: (801) 675-5000

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99348Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes1414$0
81002Urinalysis, manual test1313$0
80047Blood test, basic group of blood chemicals (calcium, ionized)1211$0
99342Residence visit for new patient with low level of medical decision making, per day, if using time, at least 30 minutes1212$0
View full utilization report →

Insurance plans in this area (ZIP 23112)

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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: 5294960696View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1225120967 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Physician Assistant. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Midlothian, Virginia; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
3 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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