Unknown Individual – Student in an Organized Health Care Education/Training Program, NPI 1124515382

Student in an Organized Health Care Education/Training Program

Unknown Individual is a healthcare provider. based in Birmingham, Alabama. specializing in Student in an Organized Health Care Education/Training Program. The NPI Number for Unknown Individual is 1124515382

Main info

Organization

Inactive

8 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1124515382

Phone

(205) 783-3191

Address

817 PRINCETON AVE SW STE 106

Deactivation Date

9 June 2021

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2059302950

Graduation Year

2018 (8 years ago)

PAC ID

3173955770

Group Practice PAC ID

0648223602

Professional Enrollment ID

I20191120002277

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience5

Completeness75

Years active:0State licenses:0Digital endpointsOther names

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Provider Addresses for Unknown Individual

106, Princeton Avenue Southwest, Elyton, Birmingham, Jefferson County, Alabama, 35211, United States
BIRMINGHAM, AL 352111340
Phone: (205) 783-3191
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)

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 35211)

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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: 0648223602View full group profile

Name	Specialty	State
FELIX R DULANTO (MD)	Family Practice	AL
JEFFREY LEE LOVE (M.D.)	Preventive Medicine, Emergency Medicine	KY
DR. LARISA VIKTOROVNA RUSSELL (M.D.)	Family Practice, Emergency Medicine, Family Practice	AL
BARNEY A. MCINTIRE (M.D.)	Emergency Medicine, Internal Medicine	AL
DR. ANIQA BAQAUDDIN (M.D)	Family Practice	KY
DR. RICHARD DANIEL PRICE (M.D.)	-	AL
DR. EVAN DANE SMOTHERS (D.O.)	Family Practice	TN
DAVID EUGEN WEVER (M.D.)	Family Practice, Diagnostic Radiology	AL
DR. JON C BERNREUTER (M.D.)	-	AL
KATHERINE HOWELL TAYLOR (NP)	Nurse Practitioner	FL

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?

NPI 1124515382 is assigned to Unknown Individual under the national enumeration system.

How do I interpret inactive records for Unknown Individual?

Treat inactive as a signal to verify Unknown Individual through official channels.

What field does Unknown Individual work in?

You can think of Unknown Individual as practicing within Student in an Organized Health Care Education/Training Program. Clinical services aligned with this taxonomy classification.

What location shows for Unknown Individual?

We surface Birmingham, Alabama for Unknown Individual based on available NPPES addresses.

Is Unknown Individual a real provider?

This page reflects official NPPES data for NPI 1124515382. Always confirm identity and privileges with the practice and licensing boards.