Unknown Individual – Physician Assistant, NPI 1093923005

Unknown Individual is a healthcare provider. based in Elma, Washington. specializing in Physician Assistant. They hold a License No. OA10000077 (WA). The NPI Number for Unknown Individual is 1093923005

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093923005
Phone
(360) 482-5300
Address
PO BOX O
Deactivation Date
21 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1976 (50 years ago)
PAC ID
3375430366
Professional Enrollment ID
I20120525000467
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

  • PO BOX O

    11 SCHOUWEILER RD

    ELMA, WA 985410529

    Phone: (360) 482-5300

    Fax: (360) 482-5900

    Type: Mailing

  • 11 SCHOUWEILER RD

    ELMA, WA 985419306

    Phone: (360) 482-5300

    Fax: (360) 482-5900

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $153.

Total Amount is formed as General ($153) + Research ($0) + Ownership ($0) = $153.

Last reported payment date: 2024-01-15 • Largest payer in this snapshot: Medtronic, Inc. ($140).

Total Amount

$153

General + Research + Ownership

Payments

2

Total payment records

General Amount

$153

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-01-15

Latest reported date

Top Companies

Largest payers in this snapshot

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 minutes12294$0
36415Insertion of needle into vein for collection of blood sample8076$0
99215Established patient office or other outpatient visit, 40-54 minutes2928$0
99213Established patient office or other outpatient visit, 20-29 minutes2420$0
View full utilization report →

Insurance plans in this area (ZIP 98541)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1093923005 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Physician Assistant in this dataset. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Elma, Washington; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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