Unknown Individual – Family Medicine Physician, NPI 1104887041

Unknown Individual is a healthcare provider. based in Gadsden, Alabama. specializing in Family Medicine Physician. They hold a License No. 14313 (AL). The NPI Number for Unknown Individual is 1104887041

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104887041
Phone
(256) 413-1095
Address
PO BOX 585
Deactivation Date
21 June 2021

Doctor Profile

Medical School Name
MEDICAL COLLEGE OF PENNSYLVANIA
Secondary Phone
2564131095
Graduation Year
1979 (47 years ago)
PAC ID
6608042098
Professional Enrollment ID
I20120106000332
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

  • PO BOX 585

    GADSDEN, AL 359020585

    Phone: (256) 413-1095

    Fax: (256) 413-7162

    Type: Mailing

  • Hollingsworth Avenue, Rainbow City, Etowah County, Alabama, 35906, United States

    RAINBOW CITY, AL 359063141

    Phone: (256) 413-1095

    Fax: (256) 413-7162

    Type: Location

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.

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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 35902)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
INTERNAL MEDICINEAL81002Urinalysis, manual test4327

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1104887041 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Gadsden?
Unknown Individual currently maps to Gadsden, Alabama in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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