Unknown Individual – Family Medicine Physician, NPI 1598705436

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Ozark, Alabama. specializing in Family Medicine Physician. They hold a License No. 7636 (AL). The NPI Number for Unknown Individual is 1598705436

Main info

Organization

Inactive

52 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1598705436

Phone

(334) 443-1211

Address

POST OFFICE BOX 863

Deactivation Date

15 June 2021

Doctor Profile

Medical School Name

LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS

Secondary Phone

3347745116

Graduation Year

1974 (52 years ago)

PAC ID

0749368926

Group Practice PAC ID

3476466327

Professional Enrollment ID

I20100623000476

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience19

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

POST OFFICE BOX 863
OZARK, AL 363610863
Phone: (334) 443-1211
Fax: (334) 443-0131
Type: Mailing
145, Katherine Avenue, Ozark, Dale County, Alabama, 36360, United States
OZARK, AL 363601976
Phone: (334) 774-5100
Fax: (334) 774-5110
Type: Location

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 36361)

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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: 3476466327View full group profile

Name	Specialty	State
DR. MARK BRIAN ELLIS (D.O.)	Family Practice, Internal Medicine	AL
VINSON LEWIS JOHNSON (CRNP)	Nurse Practitioner	AL
DR. ROBERT J KREUTZMANN (MD)	Family Practice, Preventive Medicine	AL
CONNIE A CHANDLER (MD)	-	AL
RONALD WAYNE HOLLAND (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
JOSEPH DANE PARDEN (CRNA)	Certified Registered Nurse Anesthetist (Crna)	AL
MS. PATRICIA DIANE BREWER (FNP-BC, CRNP)	Nurse Practitioner	AL
SHERYL A. JERNIGAN (ARNP)	Nurse Practitioner	FL
KAYLA BROOKE RUSSELL (FNP-C)	Nurse Practitioner	AL
DAVID ALAN HODGETT (MD)	General Surgery	IL