Unknown Individual – Pain Medicine Physician, NPI 1679865695

Unknown Individual is a healthcare provider. based in Eglin afb, Florida. specializing in Pain Medicine Physician. They hold a License No. ME128640 (FL). The NPI Number for Unknown Individual is 1679865695

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1679865695
Phone
(321) 255-6670
Address
307 BOATNER RD STE 114
Deactivation Date
23 April 2026
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness75
Years active:0State licenses:3Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 307 BOATNER RD STE 114

    EGLIN AFB, FL 32542

    Phone: (321) 255-6670

    Type: Location

  • 307 Boatner Rd Ste 114

    Eglin AFB, FL 32542

    Phone: (321) 255-6670

    Type: Location

  • 6439 GARNERS FERRY RD

    COLUMBIA, SC 292091638

    Phone: (803) 776-4000

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $96.

Total Amount is formed as General ($96) + Research ($0) + Ownership ($0) = $96.

Last reported payment date: 2024-09-13 • Largest payer in this snapshot: SPR Therapeutics, Inc ($96).

Total Amount

$96

General + Research + Ownership

Payments

1

Total payment records

General Amount

$96

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-13

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
SPR Therapeutics, Inc$96
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 32542)

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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 1679865695.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Pain Medicine Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Eglin Afb, Florida; more addresses can appear in NPPES.
How many locations tie to this NPI?
4 practice locations appear in the available data.

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