Unknown Individual – Family Medicine Physician, NPI 1124048939

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Robertsdale, Alabama. specializing in Family Medicine Physician. They hold a License No. 31964 (AL). The NPI Number for Unknown Individual is 1124048939

Main info

Organization

Inactive

29 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124048939

Phone

(251) 424-1160

Address

21141 State Highway 59 Ste 1

Deactivation Date

23 January 2025

Doctor Profile

Medical School Name

MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE

Secondary Phone

2514241160

Graduation Year

1997 (29 years ago)

PAC ID

9537146352

Group Practice PAC ID

5193741759

Professional Enrollment ID

I20121105000157

Contacts

Secure Messaging

douglas.caron.3@1599.direct.athenahealth.com

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

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

Provider Addresses for Unknown Individual

21141 State Highway 59 Ste 1
Robertsdale, AL 365676740
Phone: (251) 424-1160
Fax: (251) 424-1161
Type: Location
South Baldwin Medical Center Urgent Care Walk-in Center, 101, East 15th Avenue, Gulf Shores, Baldwin County, Alabama, 36542, United States
GULF SHORES, AL 365423501
Phone: (251) 962-1250
Fax: (251) 967-7832
Type: Mailing

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.

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 36567)

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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	81002	Urinalysis, manual test	34	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: 5193741759View full group profile

Name	Specialty	State
CAROL PATRICIA MOTLEY (MD)	-	AL
GEORGE C GRAVES (M.D.)	-	AL
DR. HARRISON B PEARL (M.D.)	N E U R O L O G Y	AL
DR. KIMBERLY WAYNETTE ROMAN (MD)	-	AL
MR. JERRY WAYNE JR. BARTON (NP)	Nurse Practitioner	AL
LISA ELLEN FIELD (CRNP)	-	AL
MARILYN COURTNEY FOREHAND (CRNP)	Nurse Practitioner	AL
GREGORY W JONES (MD)	-	AL
DR. BRIAN HINSON SUMRALL (M.D.)	Pulmonary Disease, Critical Care (Intensivists), Internal Medicine	AL
DR. RICHARD CRAIG JR. BROWN (D.O.)	O B S T E T R I C S/ G Y N E C O L O G Y	AL