Unknown Individual – Surgical Critical Care Physician, NPI 1912957853

Unknown Individual is a healthcare provider. based in Orange park, Florida. specializing in Surgical Critical Care Physician. They hold a License No. MD038648E (PA). The NPI Number for Unknown Individual is 1912957853

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1912957853
Phone
(904) 272-9041
Address
1887 KINGSLEY AVE
Deactivation Date
12 June 2024
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

  • 1887, Kingsley Avenue, Orange Park, Clay County, Florida, 32073, United States

    SUITE 1900

    ORANGE PARK, FL 320734416

    Phone: (904) 272-9041

    Fax: (904) 276-9992

    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 1 Open Payments records for all available years, with a total value of $29.

Total Amount is formed as General ($29) + Research ($0) + Ownership ($0) = $29.

Last reported payment date: 2023-04-14 • Largest payer in this snapshot: Medtronic, Inc. ($29).

Total Amount

$29

General + Research + Ownership

Payments

1

Total payment records

General Amount

$29

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-04-14

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Medtronic, Inc.$29
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 32073)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1912957853 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Surgical Critical Care Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Orange Park, Florida for Unknown Individual; download NPPES for the complete set.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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