Unknown Individual – Surgical Physician Assistant, NPI 1265479877

Unknown Individual is a healthcare provider. based in Spokane, Washington. specializing in Surgical Physician Assistant. They hold a License No. PA-619 (ID). The NPI Number for Unknown Individual is 1265479877

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1265479877
Phone
(509) 456-0262
Address
62 W 7TH AVE STE 110
Deactivation Date
30 August 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5094743131
Graduation Year
2003 (23 years ago)
PAC ID
6204821937
Group Practice PAC ID
7911069703
Professional Enrollment ID
I20040420000792

Contacts

Secure Messaging
jkonyu216537@wm.providencedirect.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • West 7th Avenue, Spokane, Spokane County, Washington, 99258, United States

    SPOKANE, WA 992042321

    Phone: (509) 456-0262

    Fax: (509) 462-5059

    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)

CMS reports 1 Open Payments records for all available years, with a total value of $77.

Total Amount is formed as General ($77) + Research ($0) + Ownership ($0) = $77.

Last reported payment date: 2023-03-16 • Largest payer in this snapshot: Alnylam Pharmaceuticals Inc. ($77).

Total Amount

$77

General + Research + Ownership

Payments

1

Total payment records

General Amount

$77

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-03-16

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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 99204)

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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: 7911069703View full group profile
NameSpecialtyState
Thoracic Surgery, General SurgeryWA
Nurse PractitionerWA
Vascular Surgery, Cardiac Surgery, Thoracic SurgeryWA
Cardiac SurgeryNM
Nurse PractitionerWI
Nurse PractitionerWA
Physician AssistantWA
Physician AssistantWA
Physician AssistantWA
Cardiac SurgeryMA

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1265479877.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Surgical Physician Assistant is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Spokane, Washington in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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