Unknown Individual – Pulmonary Disease Physician, NPI 1124023361

Unknown Individual is a healthcare provider. based in Aberdeen, Washington. specializing in Pulmonary Disease Physician. They hold a License No. MD00020876 (WA). The NPI Number for Unknown Individual is 1124023361

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124023361
Phone
(253) 588-7911
Address
PO BOX 1787
Deactivation Date
9 October 2025

Doctor Profile

Medical School Name
OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2082398008
Graduation Year
1980 (46 years ago)
PAC ID
2466485909
Group Practice PAC ID
8426149758
Professional Enrollment ID
I20050914001255
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

  • PO BOX 1787

    ABERDEEN, WA 98520

    Phone: (253) 588-7911

    Type: Mailing

  • Grays Harbor Community Hospital East Campus, 1006, North H Street, Bel-Aire, Aberdeen, Grays Harbor County, Washington, 98520, United States

    ABERDEEN, WA 98520

    Phone: (360) 537-6496

    Fax: (360) 537-6322

    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 98520)

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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: 8426149758View full group profile
NameSpecialtyState
N E U R O S U R G E R YID
O B S T E T R I C S/ G Y N E C O L O G YID
-MO
Physician AssistantID
-ID
Emergency MedicineID
O B S T E T R I C S/ G Y N E C O L O G YOK
-ID
Family PracticeOK
Orthopedic SurgeryID

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1124023361 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Pulmonary Disease Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Aberdeen, Washington?
If you are local to Aberdeen, 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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