Unknown Individual – Family Medicine Physician, NPI 1104883503

Unknown Individual is a healthcare provider. based in Spokane, Washington. specializing in Family Medicine Physician. They hold a License No. 00011131 (WA). The NPI Number for Unknown Individual is 1104883503

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104883503
Phone
(509) 489-1150
Address
5904 N DIVISION
Deactivation Date
24 May 2023

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
5094891150105
Graduation Year
1965 (61 years ago)
PAC ID
3870547276
Group Practice PAC ID
9931153863
Professional Enrollment ID
I20050309000250
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

  • 5904, North Division Street, Spokane, Spokane County, Washington, 99218, United States

    SPOKANE, WA 99208

    Phone: (509) 489-1150

    Fax: (509) 482-6010

    Type: Location

  • West Newkirk Road, Spokane County, Washington, United States

    SPOKANE, WA 99224

    Phone: (509) 624-8594

    Fax: (509) 624-8594

    Type: Mailing

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 99208)

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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: 9931153863View full group profile
NameSpecialtyState
BOBBI WOODWARD (N.P.)
-WA
MS. SUSAN E JENSEN (PA-C)
-OR

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1104883503.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Family Medicine Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Spokane, Washington?
If you are local to Spokane, Washington, Unknown Individual may be relevant to your search.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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