Unknown Individual – Family Medicine Physician, NPI 1508861402

Unknown Individual is a healthcare provider. based in Selma, Alabama. specializing in Family Medicine Physician. They hold a License No. 16514 (AL). The NPI Number for Unknown Individual is 1508861402

Main info

Organization
Inactive
35 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1508861402
Phone
(334) 875-4184
Address
1023 MEDICAL CENTER PKWY
Deactivation Date
29 May 2025

Doctor Profile

Medical School Name
UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE
Secondary Phone
3345669800
Graduation Year
1991 (35 years ago)
PAC ID
7214061704
Group Practice PAC ID
3476570912
Professional Enrollment ID
I20100819000541
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

  • Medical Center Parkway, Selma, Dallas County, Alabama, 36701, United States

    SUITE 200

    SELMA, AL 367016780

    Phone: (334) 875-4184

    Fax: (334) 874-3511

    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 212 Open Payments records for all available years, with a total value of $3,272.

Total Amount is formed as General ($3,272) + Research ($0) + Ownership ($0) = $3,272.

Last reported payment date: 2024-12-12 • Largest payer in this snapshot: Lilly USA, LLC ($512).

Total Amount

$3,272

General + Research + Ownership

Payments

212

Total payment records

General Amount

$3,272

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-12

Latest reported date

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
J0897Injection, denosumab, 1 mg1,20012$0
99214Established patient office or other outpatient visit, 30-39 minutes279102$0
36415Insertion of needle into vein for collection of blood sample256106$0
83036Hemoglobin a1c level10845$0
99213Established patient office or other outpatient visit, 20-29 minutes8051$0
View full utilization report →

Insurance plans in this area (ZIP 36701)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEAL90670Pneumococcal vaccine for injection into muscle1111

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: 3476570912View full group profile
NameSpecialtyState
Nurse PractitionerAL
Nurse PractitionerAL
Family PracticeKY
Family PracticeAL
Nurse PractitionerAL
Family PracticeAL
Nurse PractitionerAL
-AL
Nurse PractitionerAL
Nurse PractitionerAL

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1508861402 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Selma?
Unknown Individual currently maps to Selma, Alabama in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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