Unknown Individual – Orthopaedic Surgery Physician, NPI 1215008180

Unknown Individual is a healthcare provider. based in Olympia, Washington. specializing in Orthopaedic Surgery Physician. They hold a License No. MD00017945 (WA). The NPI Number for Unknown Individual is 1215008180

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215008180
Phone
(360) 491-8439
Address
PO BOX 368
Deactivation Date
10 July 2025

Doctor Profile

Medical School Name
GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3604914211
Graduation Year
1976 (50 years ago)
PAC ID
3971645441
Group Practice PAC ID
2365337508
Professional Enrollment ID
I20100121000331
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 368

    OLYMPIA, WA 985070368

    Phone: (360) 491-8439

    Fax: (360) 491-6328

    Type: Mailing

  • 615, Lilly Road Northeast, Olympia, Thurston County, Washington, 98506, United States

    SUITE 100

    OLYMPIA, WA 985065117

    Phone: (360) 491-4211

    Fax: (360) 493-0407

    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 98507)

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Provider's Procedures

Unknown Individual performs procedures in Orthopaedic Surgery Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ORTHOPEDIC SURGERYWA20610Aspiration and/or injection of large joint or joint capsule224133

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: 2365337508View full group profile
NameSpecialtyState
Orthopedic SurgeryWA
A N E S T H E S I O L O G YNH
Physician AssistantWA
-TX
A N E S T H E S I O L O G YWA
Interventional Pain Management, Physical Medicine And RehabilitationWA
-WA
Physician AssistantWA
Orthopedic SurgeryWA
Orthopedic SurgeryIA

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1215008180 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Orthopaedic Surgery Physician. Clinical services aligned with this taxonomy classification.
Where in Washington is Unknown Individual registered?
Use Olympia, Washington as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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