Unknown Individual – Emergency Medicine Physician, NPI 1710962535

Unknown Individual is a healthcare provider. based in Evergreen, Alabama. specializing in Emergency Medicine Physician. They hold a License No. MD10163 (AL). The NPI Number for Unknown Individual is 1710962535

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710962535
Phone
(251) 578-2480
Address
101 CRESTVIEW AVE
Deactivation Date
17 April 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Secondary Phone
2515784300
Graduation Year
1980 (46 years ago)
PAC ID
3173560968
Group Practice PAC ID
6305942145
Professional Enrollment ID
I20070621000173
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

Provider Addresses for Unknown Individual

  • 101 CRESTVIEW AVE

    EVERGREEN, AL 364013333

    Phone: (251) 578-2480

    Fax: (251) 578-1055

    Type: Location

  • 101, Montesano Drive, Evergreen, Conecuh County, Alabama, 36401, United States

    EVERGREEN, AL 364012610

    Phone: (251) 578-1382

    Type: Mailing

  • 847 W Bypass Ste A

    Andalusia, AL 364204747

    Phone: (334) 222-1366

    Fax: (334) 222-1150

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 5 Open Payments records for all available years, with a total value of $92.

Total Amount is formed as General ($92) + Research ($0) + Ownership ($0) = $92.

Last reported payment date: 2024-11-05 • Largest payer in this snapshot: Abbott Laboratories ($21).

Total Amount

$92

General + Research + Ownership

Payments

5

Total payment records

General Amount

$92

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-05

Latest reported date

Top Companies

Largest payers in this snapshot

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
99213Established patient office or other outpatient visit, 20-29 minutes1313$0
View full utilization report →

Insurance plans in this area (ZIP 36401)

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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: 6305942145View full group profile
NameSpecialtyState
Family PracticeAL
Nurse PractitionerAL
Nurse PractitionerAL
Nurse PractitionerAL

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1710962535 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Evergreen?
Unknown Individual currently maps to Evergreen, Alabama in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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