Unknown Individual – Interventional Pain Medicine Physician, NPI 1114129418

Unknown Individual is a healthcare provider. based in Richland, Washington. specializing in Interventional Pain Medicine Physician. They hold a License No. MD00018892 (WA). The NPI Number for Unknown Individual is 1114129418

Main info

Organization
Inactive
62 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114129418
Phone
(509) 946-3340
Address
PO BOX 1408
Deactivation Date
5 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1964 (62 years ago)
PAC ID
9739172131
Professional Enrollment ID
I20120912000349
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • PO BOX 1408

    RICHLAND, WA 993521408

    Phone: (509) 946-3340

    Fax: (509) 943-7909

    Type: Mailing

  • Jadwin Avenue, Richland, Benton County, Washington, 99354, United States

    SUITE 201

    RICHLAND, WA 993523437

    Phone: (509) 946-3340

    Fax: (509) 943-7909

    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.

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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
99213Established patient office or other outpatient visit, 20-29 minutes2,084234$0
99211Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional6250$0
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Insurance plans in this area (ZIP 99352)

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Provider's Procedures

Unknown Individual performs procedures in Interventional Pain Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERVENTIONAL PAIN MANAGEMENTWA62311Injections of substances into lower or sacral spine3024

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1114129418.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Interventional Pain Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Richland, Washington in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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