Unknown Individual – Family Medicine Physician, NPI 1063588002

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Alexander city, Alabama. specializing in Family Medicine Physician. They hold a License No. 1813 (AL). The NPI Number for Unknown Individual is 1063588002

Main info

Organization

Inactive

67 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1063588002

Phone

(256) 234-4295

Address

859 AIRPORT DR

Deactivation Date

1 July 2022

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2562344295

Graduation Year

1959 (67 years ago)

PAC ID

3971414848

Group Practice PAC ID

3971523457

Professional Enrollment ID

I20091207000364

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

859, Airport Drive, Bevelle, Alexander City, Tallapoosa County, Alabama, 35010, United States
ALEXANDER CITY, AL 350103443
Phone: (256) 234-4295
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)

CMS reports 1 Open Payments records for all available years, with a total value of $13.

Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.

Last reported payment date: 2023-01-18 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($13).

Total Amount

$13

General + Research + Ownership

Payments

Total payment records

General Amount

$13

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2023-01-18

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
Novartis Pharmaceuticals Corporation	$13

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 35010)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	AL	83036	Hemoglobin A1C level	221	110
FAMILY MEDICINE	AL	90670	Pneumococcal vaccine for injection into muscle	49	49
FAMILY MEDICINE	AL	93922	Ultrasound study of arteries of both arms and legs	97	97

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3971523457View full group profile