Unknown Individual – Surgery Physician, NPI 1164830923

Surgery Physician

Unknown Individual is a healthcare provider. based in Gadsden, Alabama. specializing in Surgery Physician. They hold a License No. 1435 (AL). The NPI Number for Unknown Individual is 1164830923

Main info

Organization

Inactive

12 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1164830923

Phone

(256) 459-4202

Address

605 S 3RD ST

Deactivation Date

1 March 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2564674731

Graduation Year

2014 (12 years ago)

PAC ID

0143440974

Group Practice PAC ID

7113231945

Professional Enrollment ID

I20140930001111

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

605 S 3RD ST
GADSDEN, AL 359015303
Phone: (256) 459-4202
Fax: (256) 515-7927
Type: Mailing
900 GOODYEAR AVE
SUITE B
GADSDEN, AL 359031108
Phone: (256) 492-0020
Fax: (256) 492-0029
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 35901)

Loading plans...

Provider's Procedures

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

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
GENERAL SURGERY	AL	36556	Insertion of central venous catheter for infusion, patient 5 years or older	30	27

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: 7113231945View full group profile

Name	Specialty	State
MRS. TRACY CALHOUN (FNP-BC)	Nurse Practitioner	AL
RACHEL DUNN (CRNP)	Nurse Practitioner	TX
SABRINA NICOLE MORGAN (M.D.)	Internal Medicine	TN
MARIAN FLORES MANANKIL (MD)	Cardiac Electrophysiology, Cardiovascular Disease (Cardiology), Internal Medicine	AL
DAVID N SIMMONS (M.D.)	Diagnostic Radiology	AL
JESSICA PARRIS (CRNP)	Nurse Practitioner	AL
DR. GHANSHYAM PATEL (M.D.)	Cardiovascular Disease (Cardiology)	AL
DR. KEWAL K VERMA (M.D.)	-	AL
MRS. JESSICA VOSS MAYS (CRNP, FNP)	Nurse Practitioner	AL
LISA DIANE FOREMAN (NP)	Nurse Practitioner	AL