Unknown Individual – Geriatric Medicine (Family Medicine) Physician, NPI 1174524052

Unknown Individual is a healthcare provider. based in Eugene, Oregon. specializing in Geriatric Medicine (Family Medicine) Physician. They hold a License No. MD155676 (OR). The NPI Number for Unknown Individual is 1174524052

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1174524052
Phone
(541) 228-3049
Address
2650 SUZANNE WAY
Deactivation Date
2 November 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

  • 2650, Suzanne Way, Eugene, Lane County, Oregon, 97408, United States

    SUITE #200

    EUGENE, OR 974087319

    Phone: (541) 228-3049

    Fax: (541) 228-3182

    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 97408)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1174524052 on file in the registry.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Geriatric Medicine (Family Medicine) Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Eugene?
Unknown Individual currently maps to Eugene, Oregon in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.