Unknown Individual – Family Medicine Physician, NPI 1417045337

Unknown Individual is a healthcare provider. based in Butler, Alabama. specializing in Family Medicine Physician. They hold a License No. 28458 (AL). The NPI Number for Unknown Individual is 1417045337

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1417045337
Phone
(205) 459-5506
Address
1406 E Pushmataha St
Deactivation Date
16 December 2021

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Secondary Phone
2514324117
Graduation Year
2004 (22 years ago)
PAC ID
9830274653
Group Practice PAC ID
1658356308
Professional Enrollment ID
I20080304000463

Contacts

Other Endpoint
Gilbertown
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 1406 E Pushmataha St

    Butler, AL 369042728

    Phone: (205) 459-5506

    Fax: (205) 459-5503

    Type: Location

  • 1406, East Pushmataha Street, Green Acres, Butler, Choctaw County, Alabama, 36904, United States

    BUTLER, AL 369042728

    Phone: (205) 459-5506

    Fax: (205) 459-5503

    Type: Location

  • 603, Rachel Court, Bay Minette, Baldwin County, Alabama, 36507, United States

    BAY MINETTE, AL 365074190

    Phone:

    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 36904)

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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: 1658356308View full group profile
NameSpecialtyState
DR. NAUSHEEN FARUQI (MD)
Internal MedicineAL
DR. JAMES O JR. DEVANEY (M.D.)
-AL
DR. PAMELA NANCY BARBER (M.D.)
-MO
KAREN MCGHEE (CRNP)
Nurse PractitionerAL
TAMEKIA DANIELLE CUNNINGHAM (FNP-C)
Nurse PractitionerMO
DR. PATRICIA LYN MATTO (D.O.)
Family PracticeVA
MS. SHARON BRAMMER (CRNP)
Nurse PractitionerAL
WESLEY DEWAYNE LEWIS (O.D.)
-FL
JULIA DANNELLEY (M.D.)
Internal MedicineAL
NELSON G. MONROY (M.D.)
P S Y C H I A T R YVA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1417045337?
NPI 1417045337 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Butler?
Public fields place Unknown Individual around Butler, Alabama. Always confirm the exact site before visiting.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.