Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1306000898

Child & Adolescent Psychiatry Physician

Unknown Individual is a healthcare provider. based in Marysville, Washington. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. OP00001801 (WA). The NPI Number for Unknown Individual is 1306000898

Main info

Organization

Inactive

33 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1306000898

Phone

(206) 932-9025

Address

3955 156TH ST NE

Deactivation Date

22 October 2021

Doctor Profile

Medical School Name

WESTERN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF DENTAL MED

Secondary Phone

8442025555

Graduation Year

1993 (33 years ago)

PAC ID

9032156534

Group Practice PAC ID

7416233549

Professional Enrollment ID

I20050415000607

Data current as of

20 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

Smokey Point Behavioral Hospital, 3955, 156th Street Northeast, Marysville, Snohomish County, Washington, 98271, United States
MARYSVILLE, WA 982714831
Phone: (206) 932-9025
Type: Mailing
Northup Way, Northup, Bellevue, King County, Washington, 98004-4452, United States
BELLEVUE, WA 980051966
Phone: (206) 686-3006
Fax: (206) 686-3006
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 98271)

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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: 7416233549View full group profile

Name	Specialty	State
HAMAYUN N AHMED (M.D.)	P S Y C H I A T R Y	PA
TESHOME SHIKESSO (NP PSYCH/MENTAL HEAL)	Nurse Practitioner	WA
LAMIN K SANNEH	Nurse Practitioner	WA
HASSAN A ELMI	Nurse Practitioner	WA
RICHARD EMODOGO (PMHNP)	Nurse Practitioner	TX
MARYANNE WAMBUI MIRIE (RN)	Nurse Practitioner	WA
JUSTIN MADUOBI	Nurse Practitioner	WA
BRIAN MACARAIG ORGAN	Nurse Practitioner	NV
JESSICA DAWN RAMSEY (PMHNP)	Nurse Practitioner	WA
HENRY TAMBE (ARNP/PMHNP-BC)	Nurse Practitioner	WA

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1306000898 for Unknown Individual, then check state licensing separately.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What is Unknown Individual's primary classification?

Child & Adolescent Psychiatry Physician 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 Marysville, 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.