Unknown Individual – Family Medicine Physician, NPI 1760452999

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Tallassee, Alabama. specializing in Family Medicine Physician. They hold a License No. 00003909 (AL). The NPI Number for Unknown Individual is 1760452999

Main info

Organization

Inactive

60 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1760452999

Phone

(334) 283-3111

Address

875 FRIENDSHIP RD

Deactivation Date

13 February 2025

Doctor Profile

Medical School Name

UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE

Secondary Phone

3342833111

Graduation Year

1966 (60 years ago)

PAC ID

7315933744

Group Practice PAC ID

2062408487

Professional Enrollment ID

I20101118000822

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

875, Friendship Road, Jordanville, Tallassee, Elmore County, Alabama, 36078, United States
TALLASSEE, AL 360781255
Phone: (334) 283-3111
Fax: (334) 283-3656
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)

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 36078)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
FAMILY MEDICINE	AL	81002	Urinalysis, manual test	92	58

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: 2062408487View full group profile

Name	Specialty	State
ZANE PENTON KELLY (CRNP)	Nurse Practitioner	AL
MR. DERAY JUNIOR WILLIAMS (CRNP)	Nurse Practitioner	AL
DR. WILLIAM CRAWFORD FREEMAN (M.D.)	-	AL
DR. VAN MILLIN (DO)	Family Practice	GA
DR. THOMAS DEVERELL BIANCHI (M.D.)	Gastroenterology, Internal Medicine	AL
CECILIA KEARNS (CRNP)	Nurse Practitioner	AL
MS. CANDACE D MANGUM (CRNP)	Nurse Practitioner	AL
DR. VINIT V PATEL (M D)	-	AL
MICHAEL A COURTNEY (M.D.)	General Surgery	AL
BARBARA JEAN WATTS (NP)	-	AL