Unknown Individual – Emergency Medicine Physician, NPI 1386087096

Unknown Individual is a healthcare provider. based in Lake stevens, Washington. specializing in Emergency Medicine Physician. They hold a License No. MD60658839 (WA). The NPI Number for Unknown Individual is 1386087096

Main info

Organization
Inactive
13 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1386087096
Phone
(360) 658-2488
Address
16410 84TH ST NE
Deactivation Date
31 January 2022

Doctor Profile

Medical School Name
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3606582488
Graduation Year
2013 (13 years ago)
PAC ID
8628204534
Group Practice PAC ID
4284521691
Professional Enrollment ID
I20160830002415
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

Provider Addresses for Unknown Individual

  • 16410 84TH ST NE

    SUITE D-605

    LAKE STEVENS, WA 982589060

    Phone: (360) 658-2488

    Type: Mailing

  • 747 BROADWAY

    SEATTLE, WA 981224379

    Phone: (206) 386-6000

    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 98258)

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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: 4284521691View full group profile
NameSpecialtyState
Emergency MedicineWA
Emergency MedicineWA
-WA
Emergency MedicineMA
Emergency MedicineCA
-IL
Emergency MedicineCA
Emergency MedicineWA
Emergency MedicineWA
Emergency MedicineIL

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1386087096 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?
Emergency Medicine Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Lake Stevens, Washington may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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