Unknown Individual – Family Medicine Physician, NPI 1174517874

Family Medicine Physician

Unknown Individual is a healthcare provider. based in El dorado, Arkansas. specializing in Family Medicine Physician. They hold a License No. C6418 (AR). The NPI Number for Unknown Individual is 1174517874

Main info

Organization

Inactive

43 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1174517874

Phone

(870) 863-5135

Address

425 W OAK ST

Deactivation Date

17 October 2022

Doctor Profile

Medical School Name

UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE

Secondary Phone

Graduation Year

1983 (43 years ago)

PAC ID

8921017641

Professional Enrollment ID

I20060508000937

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

425, West Oak Street, El Dorado, Union County, Arkansas, 71730, United States
EL DORADO, AR 717304566
Phone: (870) 863-5135
Fax: (870) 863-5137
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 71730)

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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	AR	20610	Aspiration and/or injection of large joint or joint capsule	46	37
FAMILY MEDICINE	AR	85610	Blood test, clotting time	183	18

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?

The NPI 1174517874 uniquely identifies Unknown Individual in U.S. healthcare data.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What type of care does Unknown Individual provide?

Unknown Individual's profile centers on Family Medicine Physician. Clinical services aligned with this taxonomy classification.

Can patients visit Unknown Individual in El Dorado, Arkansas?

For routing, start with El Dorado, Arkansas for Unknown Individual, then verify phone and hours locally.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.

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