Unknown Individual – Endocrinology, Diabetes & Metabolism Physician, NPI 1114994613

Unknown Individual is a healthcare provider. based in Seattle, Washington. specializing in Endocrinology, Diabetes & Metabolism Physician. They hold a License No. MD00044950 (WA). The NPI Number for Unknown Individual is 1114994613

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114994613
Phone
(206) 329-1760
Address
904 7TH AVE
Deactivation Date
5 June 2024

Doctor Profile

Medical School Name
HARVARD MEDICAL SCHOOL
Secondary Phone
2063091760
Graduation Year
2000 (26 years ago)
PAC ID
1759375702
Group Practice PAC ID
2163328196
Professional Enrollment ID
I20050627000045
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

  • Kelley Ross Pharmacy, 904, 7th Avenue, Central Business District, First Hill, Seattle, King County, Washington, 98138, United States

    SEATTLE, WA 981041132

    Phone: (206) 329-1760

    Mailing address matches the actual address.

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
J0897Injection, denosumab, 1 mg1,08017$0
99214Established patient office or other outpatient visit, 30-39 minutes181145$0
36415Insertion of needle into vein for collection of blood sample167111$0
84443Blood test, thyroid stimulating hormone (tsh)15096$0
84481Thyroid hormone, t3 measurement, free11371$0
View full utilization report →

Insurance plans in this area (ZIP 98104)

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Provider's Procedures

Unknown Individual performs procedures in Endocrinology, Diabetes & Metabolism Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ENDOCRINOLOGYWA83036Hemoglobin A1C level13573

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: 2163328196View full group profile
NameSpecialtyState
Hospitalist, Internal MedicineWA
Nurse PractitionerCA
R H E U M A T O L O G YWA
-WA
-WA
Internal MedicineUT
Cardiovascular Disease (Cardiology), Interventional CardiologyWA
Clinical Social WorkerWA
N E P H R O L O G YWA
-WA

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 1114994613.
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 Endocrinology, Diabetes & Metabolism Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Seattle, Washington in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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