Unknown Individual – Family Medicine Physician, NPI 1780628727

Unknown Individual is a healthcare provider. based in Olympia, Washington. specializing in Family Medicine Physician. They hold a License No. MD00009875 (WA). The NPI Number for Unknown Individual is 1780628727

Main info

Organization
Inactive
64 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1780628727
Phone
(360) 748-0211
Address
PO BOX 11009
Deactivation Date
15 May 2025

Doctor Profile

Medical School Name
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
3607480211
Graduation Year
1962 (64 years ago)
PAC ID
1658289988
Group Practice PAC ID
7012825342
Professional Enrollment ID
I20040406000282
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

  • PO BOX 11009

    OLYMPIA, WA 985081009

    Phone: (360) 748-0211

    Fax: (360) 748-8732

    Type: Mailing

  • 1299, Bishop Road, Chehalis, Lewis County, Washington, 98532, United States

    CHEHALIS, WA 985328758

    Phone: (360) 748-0211

    Fax: (360) 478-8732

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 11 Open Payments records for all available years, with a total value of $234.

Total Amount is formed as General ($234) + Research ($0) + Ownership ($0) = $234.

Last reported payment date: 2024-10-10 • Largest payer in this snapshot: Novo Nordisk Inc ($85).

Total Amount

$234

General + Research + Ownership

Payments

11

Total payment records

General Amount

$234

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-10

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 98508)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GENERAL PRACTICEWA85610Blood test, clotting time48475
GENERAL PRACTICEWA94060Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration6657

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: 7012825342View 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 1780628727 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Olympia?
Public fields place Unknown Individual around Olympia, Washington. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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