Unknown Individual – Surgical Physician Assistant, NPI 1215980404

Unknown Individual is a healthcare provider. based in Elyria, Ohio. specializing in Surgical Physician Assistant. They hold a License No. 50002336 (OH). The NPI Number for Unknown Individual is 1215980404

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1215980404
Phone
(440) 329-7500
Address
630 E RIVER ST
Deactivation Date
21 August 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

  • University Hospitals Elyria Medical Center, 630, East River Street, Elyria, Lorain County, Ohio, 44035, United States

    ELYRIA, OH 440355902

    Phone: (440) 329-7500

    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 $18.

Total Amount is formed as General ($18) + Research ($0) + Ownership ($0) = $18.

Last reported payment date: 2023-11-07 • Largest payer in this snapshot: Ethicon US, LLC ($18).

Total Amount

$18

General + Research + Ownership

Payments

1

Total payment records

General Amount

$18

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-07

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Ethicon US, LLC$18
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 44035)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1215980404.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Surgical Physician Assistant. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Elyria, Ohio in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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