Unknown Individual – Internal Medicine Physician, NPI 1124095211

Unknown Individual is a healthcare provider. based in North providence, Rhode Island. specializing in Internal Medicine Physician. They hold a License No. 57821 (MA). The NPI Number for Unknown Individual is 1124095211

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124095211
Phone
(401) 456-3064
Address
200 HIGH SERVICE AVENUE
Deactivation Date
2 August 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Our Lady of Fatima Hospital, 200, High Service Avenue, Fruit Hill, North Providence, Providence County, Rhode Island, 02904, United States

    MARIAN HALL 2ND FLOOR

    NORTH PROVIDENCE, RI 029045113

    Phone: (401) 456-3064

    Fax: (401) 752-8247

    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 02904)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1124095211 is assigned to Unknown Individual under the national enumeration system.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Internal Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Rhode Island?
You will see North Providence, Rhode Island on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.