Unknown Individual – Family Medicine Physician, NPI 1780604413

Unknown Individual is a healthcare provider. based in Vancouver, Washington. specializing in Family Medicine Physician. They hold a License No. MD00033881 (WA). The NPI Number for Unknown Individual is 1780604413

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780604413
Phone
(360) 254-8025
Address
222 NE PARK PLAZA DR
Deactivation Date
12 December 2024

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, DAVIS SCHOOL OF MEDICINE
Secondary Phone
3602548025
Graduation Year
1994 (32 years ago)
PAC ID
6305861816
Group Practice PAC ID
0143118380
Professional Enrollment ID
I20051013000057
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

  • 222, Northeast Park Plaza Drive, Mill Plain One, Evergreen, Vancouver, Clark County, Washington, 98684, United States

    SIUTE 100

    VANCOUVER, WA 986845895

    Phone: (360) 254-8025

    Fax: (360) 254-8618

    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 74 Open Payments records for all available years, with a total value of $1,758.

Total Amount is formed as General ($1,758) + Research ($0) + Ownership ($0) = $1,758.

Last reported payment date: 2024-03-07 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($492).

Total Amount

$1,758

General + Research + Ownership

Payments

74

Total payment records

General Amount

$1,758

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-03-07

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes3822$0
View full utilization report →

Insurance plans in this area (ZIP 98684)

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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: 0143118380View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1780604413 on file in the registry.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Vancouver?
Public fields place Unknown Individual around Vancouver, Washington. Always confirm the exact site before visiting.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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