Unknown Individual – Family Medicine Physician, NPI 1619940087

Unknown Individual is a healthcare provider. based in Mount vernon, Washington. specializing in Family Medicine Physician. They hold a License No. MD60267444 (WA). The NPI Number for Unknown Individual is 1619940087

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619940087
Phone
(360) 428-2500
Address
1400 E KINCAID ST
Deactivation Date
31 May 2022

Doctor Profile

Medical School Name
UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Secondary Phone
3604165750
Graduation Year
1990 (36 years ago)
PAC ID
2860487287
Group Practice PAC ID
6800793522
Professional Enrollment ID
I20120514000375
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1400, East Kincaid Street, Mount Vernon, Skagit County, Washington, 98274, United States

    ATTN: CREDENTIALING

    MOUNT VERNON, WA 982744127

    Phone: (360) 428-2500

    Fax: (360) 428-6485

    Type: Mailing

  • 1415, East Kincaid Street, Mount Vernon, Skagit County, Washington, 98274, United States

    MOUNT VERNON, WA 982744126

    Phone: (360) 814-5351

    Fax: (360) 428-6485

    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 98274)

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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: 6800793522View full group profile
NameSpecialtyState
D E R M A T O L O G YNY
Otolaryngology, Allergy/Immunology, Plastic And Reconstructive Surgery, Surgical OncologyWA
Nurse PractitionerWA
Nurse PractitionerWA
-WA
Orthopedic SurgeryWA
Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)WA
Internal MedicineWA
O B S T E T R I C S/ G Y N E C O L O G YWA
G A S T R O E N T E R O L O G YWA

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 1619940087.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Mount Vernon, Washington in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.