Unknown Individual – Medical Physician Assistant, NPI 1154419901

Unknown Individual is a healthcare provider. based in Hartford, Connecticut. specializing in Medical Physician Assistant. They hold a License No. 000664 (CT). The NPI Number for Unknown Individual is 1154419901

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1154419901
Phone
(860) 714-2813
Address
131 COVENTRY ST
Deactivation Date
10 May 2023
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

  • Burgdorf/Bank of America Health Center, 131, Coventry Street, Hartford, Hartford County, Connecticut, 06112, United States

    HARTFORD, CT 061121548

    Phone: (860) 714-2813

    Fax: (860) 714-8541

    Type: Location

  • 108, Ridgewood Road, South Glastonbury, Glastonbury, Capitol Planning Region, Connecticut, 06033, United States

    GLASTONBURY, CT 060333639

    Phone: (860) 714-2813

    Fax: (860) 714-8541

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $108.

Total Amount is formed as General ($108) + Research ($0) + Ownership ($0) = $108.

Last reported payment date: 2024-12-03 • Largest payer in this snapshot: ABBVIE INC. ($108).

Total Amount

$108

General + Research + Ownership

Payments

4

Total payment records

General Amount

$108

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-03

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$108
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 06112)

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Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual 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 1154419901.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Medical Physician Assistant is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Hartford, Connecticut in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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