Unknown Individual – Urology Physician, NPI 1104842103

Unknown Individual is a healthcare provider. based in Mount vernon, Washington. specializing in Urology Physician. They hold a License No. MD00031250 (WA). The NPI Number for Unknown Individual is 1104842103

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104842103
Phone
(360) 428-2500
Address
1400 E. KINCAID STREET
Deactivation Date
12 March 2026
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

  • 1400, East Kincaid Street, Mount Vernon, Skagit County, Washington, 98274, United States

    MOUNT VERNON, WA 982744127

    Phone: (360) 428-2500

    Fax: (360) 428-6485

    Type: Mailing

  • 1311, East Division Street, Mount Vernon, Skagit County, Washington, 98274, United States

    MOUNT VERNON, WA 98274

    Phone: (360) 424-7991

    Fax: (360) 428-4377

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $50.

Total Amount is formed as General ($50) + Research ($0) + Ownership ($0) = $50.

Last reported payment date: 2023-11-09 • Largest payer in this snapshot: Axonics, Inc. ($50).

Total Amount

$50

General + Research + Ownership

Payments

2

Total payment records

General Amount

$50

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-09

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Axonics, Inc.$50
View all Open Payments →|Open Payments Risk Radar →

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 98274)

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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 1104842103 for Unknown Individual, then check state licensing separately.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Urology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Mount Vernon, Washington in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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