Unknown Individual – Clinical Psychologist, NPI 1619045051

Unknown Individual is a healthcare provider. based in Burke, Virginia. specializing in Clinical Psychologist. They hold a License No. 0810002496 (VA). The NPI Number for Unknown Individual is 1619045051

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619045051
Phone
(703) 249-7244
Address
5999 Burke Commons Rd
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8084322160
Graduation Year
1994 (32 years ago)
PAC ID
5092603514
Group Practice PAC ID
1850205360
Professional Enrollment ID
I20191111001316

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 5999 Burke Commons Rd

    3rd Floor

    Burke, VA 220152880

    Phone: (703) 249-7244

    Type: Location

  • 1441 KAPIOLANI BLVD STE 1600

    HONOLULU, HI 968144407

    Phone: (808) 432-7623

    Type: Location

  • East Jefferson Street, Croydon Park, Rockville, Montgomery County, Maryland, 20850-3827, United States

    ROCKVILLE, MD 208524908

    Phone: (301) 816-2424

    Type: Mailing

  • Burke Medical Center, 5999, Burke Commons Road, Heron Pond / Pond Spice, Burke Centre, Burke, Fairfax, Virginia, 22015-2805, United States

    3RD FLOOR

    BURKE, VA 220152880

    Phone: (703) 249-7244

    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 22015)

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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: 1850205360View full group profile
NameSpecialtyState
Nurse PractitionerHI
Nurse PractitionerHI
-HI
-HI
-CO
Clinical PsychologistHI
Clinical PsychologistHI
Certified Registered Nurse Anesthetist (Crna)WA
Nurse PractitionerHI
-HI

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1619045051 if you need a stable reference for Unknown Individual.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Burke, Virginia because that is what the record indicates for Unknown Individual.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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