Unknown Individual – Internal Medicine Physician, NPI 1194773176

Internal Medicine Physician

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Internal Medicine Physician. They hold a License No. MD16466 (OR). The NPI Number for Unknown Individual is 1194773176

Main info

Organization

Inactive

Name

Unknown Individual

NPI

1194773176

Phone

(503) 228-4533

Address

727 W. BURNSIDE

Deactivation Date

26 July 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

Old Town Clinic, 727, West Burnside Street, Pearl District, Portland, Multnomah County, Oregon, 97209, United States
PORTLAND, OR 97209
Phone: (503) 228-4533
Type: Location
Southwest 104th Avenue, Cook Park, Tigard, Washington County, Oregon, 97224, United States
TIGARD, OR 97224
Phone: (503) 228-4533
Type: Mailing

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 97209)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1194773176 for Unknown Individual, then check state licensing separately.

Is Unknown Individual excluded from programs when inactive?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Internal Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Portland, Oregon as a primary anchor for Unknown Individual unless the record lists multiple sites.

Why does Unknown Individual have multiple addresses?

2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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