Unknown Individual – Emergency Medicine Physician, NPI 1124210125

Unknown Individual is a healthcare provider. based in Destin, Florida. specializing in Emergency Medicine Physician. They hold a License No. MD44019 (FL). The NPI Number for Unknown Individual is 1124210125

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124210125
Phone
(850) 837-5077
Address
305 SAND MYRTLE TRL
Deactivation Date
25 August 2021
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

  • 305 SAND MYRTLE TRL

    DESTIN, FL 325413428

    Phone: (850) 837-5077

    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 32541)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1124210125.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Destin, Florida as a primary anchor for Unknown Individual unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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