Unknown Individual – Family Medicine Physician, NPI 1629058565

Unknown Individual is a healthcare provider. based in Deland, Florida. specializing in Family Medicine Physician. They hold a License No. OS0004023 (FL). The NPI Number for Unknown Individual is 1629058565

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1629058565
Phone
(386) 740-4083
Address
151 VICTORIA COMMONS BLVD
Deactivation Date
6 March 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

  • 151, Victoria Commons Boulevard, DeLand, Volusia County, Florida, 32724, United States

    SUITE 104

    DELAND, FL 327247722

    Phone: (386) 740-4083

    Fax: (386) 736-1218

    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)

CMS reports 4 Open Payments records for all available years, with a total value of $67.

Total Amount is formed as General ($67) + Research ($0) + Ownership ($0) = $67.

Last reported payment date: 2024-08-22 • Largest payer in this snapshot: Orexo US, Inc. ($32).

Total Amount

$67

General + Research + Ownership

Payments

4

Total payment records

General Amount

$67

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-22

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 32724)

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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 1629058565.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Deland, Florida in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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