Unknown Individual – Interventional Cardiology Physician, NPI 1124024658

Interventional Cardiology Physician

Unknown Individual is a healthcare provider. based in Birmingham, Alabama. specializing in Interventional Cardiology Physician. They hold a License No. 8266 (AL). The NPI Number for Unknown Individual is 1124024658

Main info

Organization

Inactive

53 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124024658

Phone

(205) 971-7500

Address

3686 GRANDVIEW PKWY

Deactivation Date

17 June 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2059710139

Graduation Year

1973 (53 years ago)

PAC ID

8022919869

Group Practice PAC ID

1658680434

Professional Enrollment ID

I20040308000705

Contacts

Secure Messaging

alcv@195.direct.myezyaccess.com

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience19

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

Grandview Parkway, Birmingham, Jefferson County, Alabama, 35243, United States
SUITE 720
BIRMINGHAM, AL 352433407
Phone: (205) 971-7500
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 2 Open Payments records for all available years, with a total value of $34.

Total Amount is formed as General ($34) + Research ($0) + Ownership ($0) = $34.

Last reported payment date: 2024-11-06 • Largest payer in this snapshot: Boston Scientific Corporation ($34).

Total Amount

$34

General + Research + Ownership

Payments

Total payment records

General Amount

$34

General payments

Research Amount

Research funding

Ownership Amount

Ownership interests

Ownership Count

Ownership records

Last Payment Date

2024-11-06

Latest reported date

Top Companies

Largest payers in this snapshot

Company	Amount
Boston Scientific Corporation	$34

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 35243)

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Provider's Procedures

Unknown Individual performs procedures in Interventional Cardiology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
CARDIOVASCULAR DISEASE (CARDIOLOGY)	AL	78452	Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	69	69
CARDIOVASCULAR DISEASE (CARDIOLOGY)	AL	93458	Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart	31	31

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: 1658680434View full group profile

Name	Specialty	State
JUAN MARIO BERNAL (M.D.)	Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine	AL
DR. GUSTAVO XAVIER MORALES (MD)	Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)	AL
WILLIAM CONRAD BLACK (M.D.)	Internal Medicine	AL
JACOB COFIELD	Nurse Practitioner	AL
MELISSA LEIGH HORN (CRNP)	Nurse Practitioner	AL
LOGAN GILMORE	Nurse Practitioner	AL
Unknown Individual	-	AL
VIKRAM ARORA (MD)	Cardiovascular Disease (Cardiology)	AL
ALVARO ALEJANDRO ALDANA (MD)	Cardiovascular Disease (Cardiology), Interventional Cardiology	AL
WALTER HANSFORD JR. WATFORD (MD)	-	AL

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1124024658 for Unknown Individual, then check state licensing separately.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Interventional Cardiology Physician in this dataset. Clinical services aligned with this taxonomy classification.

Where is Unknown Individual based?

Unknown Individual is tied to Birmingham, Alabama in the data we show; additional addresses may exist on the full record.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."