Unknown Individual – Emergency Medicine Physician, NPI 1073569596

Unknown Individual is a healthcare provider. based in Tacoma, Washington. specializing in Emergency Medicine Physician. They hold a License No. MD00028392 (WA). The NPI Number for Unknown Individual is 1073569596

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1073569596
Phone
(253) 968-0597
Address
9040 Jackson Ave
Deactivation Date
2 July 2021
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

Provider Addresses for Unknown Individual

  • 9040 Jackson Ave

    Tacoma, WA 984314933

    Phone: (253) 968-0597

    Type: Location

  • North Jackson Avenue, Tahoma Narrows, West End, Tacoma, Pierce County, Washington, 98465, United States

    TACOMA, WA 98431

    Phone: (253) 968-0597

    Type: Location

  • 1472, Richmond Avenue, DuPont, Pierce County, Washington, 98327, United States

    DUPONT, WA 983279702

    Phone: (504) 528-1036

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 98431)

Loading plans...

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1073569596 on file in the registry.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Tacoma, Washington.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

Similar Providers

209, Martin Luther King Jr Way, Tacoma, Pierce County, Washington, 98405, United States
NPI: 1619977659

DR. CARL SKINNER (MD)

Emergency Medicine Physician
Madigan Army Medical Center, 9040, Jackson Avenue, Tacoma, Pierce County, Washington, 98431, United States
NPI: 1558352203
3800, Summitview Avenue, Yakima, Yakima County, Washington, 98902, United States
NPI: 1184605347

DR. JAMES G LENHART (M.D.)

Family Medicine Physician
Pacific Avenue, Tacoma, Pierce County, Washington, 98418-7826, United States
NPI: 1619955424

SIMEON WESLEY ASHWORTH (DO)

Emergency Medicine Physician
Madigan Army Medical Center, 9040, Jackson Avenue, Tacoma, Pierce County, Washington, 98431, United States
NPI: 1861462368

ROGER KENNETH MANSON (M.D.)

Emergency Medicine Physician
Madigan Army Medical Center, 9040, Jackson Avenue, Tacoma, Pierce County, Washington, 98431, United States
NPI: 1457321960

BENJAMIN PAUL HARRISON (MD)

Emergency Medicine Physician
505, South 336th Street, Federal Way, King County, Washington, 98003, United States
NPI: 1346210895

DR. BRADLEY NELS YOUNGGREN (M.D.)

Emergency Medicine Physician
COMMANDER, MADIGAN ARMY MEDICAL CENTER
NPI: 1235100306

DR. DIANE DEVITA

Emergency Medicine Physician
1802, Fisher Avenue, DuPont, Pierce County, Washington, 98327, United States
NPI: 1528039757