Unknown Individual – General Practice Physician, NPI 1477550051

Unknown Individual is a healthcare provider. based in Roanoke, Alabama. specializing in General Practice Physician. They hold a License No. 00009079 (AL). The NPI Number for Unknown Individual is 1477550051

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477550051
Phone
(334) 863-2311
Address
1950 MAIN ST
Deactivation Date
27 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2562355015
Graduation Year
1968 (58 years ago)
PAC ID
9436051745
Group Practice PAC ID
9638340201
Professional Enrollment ID
I20040414001765
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Main Street, Meadow View, Roanoke, Denton County, Texas, 76262, United States

    ROANOKE, AL 362742421

    Phone: (334) 863-2311

    Fax: (334) 863-5596

    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 1 Open Payments records for all available years, with a total value of $19.

Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.

Last reported payment date: 2023-02-14 • Largest payer in this snapshot: ABBVIE INC. ($19).

Total Amount

$19

General + Research + Ownership

Payments

1

Total payment records

General Amount

$19

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-02-14

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$19
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 36274)

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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: 9638340201View full group profile
NameSpecialtyState
Internal Medicine, EndocrinologyWV
Nurse PractitionerAL
Family PracticeAL
-AL
Family PracticeAL
General SurgeryNC
General SurgeryAL
General SurgeryAL
-AL
Nurse PractitionerAL

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1477550051.
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 General Practice Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Roanoke, Alabama as a primary anchor for Unknown Individual unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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