Unknown Individual – Surgical Physician Assistant, NPI 1063525707

Unknown Individual is a healthcare provider. based in Clackamas, Oregon. specializing in Surgical Physician Assistant. They hold a License No. PA 10003778 (WA). The NPI Number for Unknown Individual is 1063525707

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1063525707
Phone
Not provided
Address
10100 SE SUNNYSIDE RD
Deactivation Date
27 October 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 10100, Southeast Sunnyside Road, Harmony, Oatfield, Metro, Clackamas County, Oregon, 97015, United States

    CLACKAMAS, OR 970158970

    Phone:

    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)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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 97015)

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Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1063525707 uniquely identifies Unknown Individual in U.S. healthcare data.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Surgical Physician Assistant. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Clackamas, Oregon. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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