Unknown Individual – Family Medicine Physician, NPI 1972550812
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1611, State Road 60, Lake Wales, Polk County, Florida, 33853, United States
LAKE WALES, FL 338534309
Phone: (863) 676-6007
Fax: (863) 676-7659
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: 2023-10-02 • Largest payer in this snapshot: 180 Medical, 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
2023-10-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| 180 Medical, Inc. | $29 |
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.
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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 33853)
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Reviews
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