Unknown Individual – General Practice Physician, NPI 1104953124

General Practice Physician

Unknown Individual is a healthcare provider. based in Broomfield, Colorado. specializing in General Practice Physician. They hold a License No. 9532 (CO). The NPI Number for Unknown Individual is 1104953124

Main info

Organization

Inactive

Name

Unknown Individual

NPI

1104953124

Phone

(303) 469-2961

Address

1272 CEDAR ST

Deactivation Date

21 November 2024

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

Provider Addresses for Unknown Individual

1272 CEDAR ST
BROOMFIELD, CO 800201451
Phone: (303) 469-2961
Type: Mailing
280 EXEMPLA CIR
LAFAYETTE, CO 800263370
Phone: (720) 536-7923
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.

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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 80020)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?

In the U.S., Unknown Individual is identified by NPI 1104953124.

Does inactive mean outdated data for Unknown Individual?

Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to General Practice Physician. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Broomfield, Colorado in registry-derived data.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.