Unknown Individual – Emergency Medicine Physician, NPI 1063486413

Unknown Individual is a healthcare provider. based in West memphis, Arkansas. specializing in Emergency Medicine Physician. They hold a License No. E0764 (AR). The NPI Number for Unknown Individual is 1063486413

Main info

Organization
Inactive
38 Years Of Experience
Name
Unknown Individual
NPI
1063486413
Phone
(870) 732-1224
Address
2201 HORIZAN RD
Deactivation Date
19 December 2024

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Secondary Phone
8707320332
Graduation Year
1988 (38 years ago)
PAC ID
1052356672
Group Practice PAC ID
3274606314
Professional Enrollment ID
I20050623001045
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2201 HORIZAN RD

    STE 4

    WEST MEMPHIS, AR 723012926

    Phone: (870) 732-1224

    Fax: (870) 732-1533

    Type: Mailing

  • 318, South Rhodes Street, Eugene Woods, West Memphis, Crittenden County, Arkansas, 72301, United States

    WEST MEMPHIS, AR 723014215

    Phone: (870) 732-1224

    Fax: (870) 732-1533

    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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99284Emergency department visit with moderate level of medical decision making1919$0
20610Aspiration and/or injection of fluid from large joint1611$0
99285Emergency department visit with high level of medical decision making1313$0
View full utilization report →

Insurance plans in this area (ZIP 72301)

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Provider's Procedures

Unknown Individual performs procedures in Emergency Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
GENERAL PRACTICEAR93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report7667

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: 3274606314View full group profile

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1063486413?
NPI 1063486413 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with West Memphis?
Public fields place Unknown Individual around West Memphis, Arkansas. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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