Unknown Individual – Obstetrics & Gynecology Physician, NPI 1790760452

Unknown Individual is a healthcare provider. based in Huntsville, Alabama. specializing in Obstetrics & Gynecology Physician. They hold a License No. 22430 (AL). The NPI Number for Unknown Individual is 1790760452

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790760452
Phone
(256) 881-9997
Address
250 CHATEAU DR SW
Deactivation Date
17 August 2023

Doctor Profile

Medical School Name
UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Secondary Phone
2568819997
Graduation Year
1995 (31 years ago)
PAC ID
4284704362
Group Practice PAC ID
7810067998
Professional Enrollment ID
I20080602000072
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

  • 250, Chateau Drive Southwest, Westbury, Huntsville, Madison County, Alabama, 35801, United States

    SUITE 100

    HUNTSVILLE, AL 358013497

    Phone: (256) 881-9997

    Fax: (256) 880-3838

    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 5 Open Payments records for all available years, with a total value of $121.

Total Amount is formed as General ($121) + Research ($0) + Ownership ($0) = $121.

Last reported payment date: 2024-10-16 • Largest payer in this snapshot: Hologic Sales and Service, LLC ($70).

Total Amount

$121

General + Research + Ownership

Payments

5

Total payment records

General Amount

$121

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-16

Latest reported date

Top Companies

Largest payers in this snapshot

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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 35801)

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Provider's Procedures

Unknown Individual performs procedures in Obstetrics & Gynecology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OBSTETRICS/GYNECOLOGYAL81002Urinalysis, manual test8880

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: 7810067998View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YAL
Nurse PractitionerAL
Nurse PractitionerAL
Nurse PractitionerAL

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1790760452 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Huntsville, Alabama.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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