Unknown Individual – Interventional Pain Medicine Physician, NPI 1114090776

Unknown Individual is a healthcare provider. based in Clearwater, Florida. specializing in Interventional Pain Medicine Physician. They hold a License No. ME55319 (FL). The NPI Number for Unknown Individual is 1114090776

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114090776
Phone
(727) 787-5555
Address
611 DRUID RD E
Deactivation Date
2 January 2025
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

  • Druid Road East, Clearwater, Pinellas County, Florida, 33764, United States

    SUITE 303

    CLEARWATER, FL 337563959

    Phone: (727) 787-5555

    Fax: (727) 789-9176

    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)

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 33756)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1114090776?
NPI 1114090776 belongs to Unknown Individual; compare other details if you need extra assurance.
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 kind of doctor is Unknown Individual?
Unknown Individual is associated with Interventional Pain Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Clearwater, Florida as the reference point for Unknown Individual, then confirm.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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