Unknown Individual – Family Medicine Physician, NPI 1376546622

Unknown Individual is a healthcare provider. based in Fordyce, Arkansas. specializing in Family Medicine Physician. They hold a License No. C4246 (AR). The NPI Number for Unknown Individual is 1376546622

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1376546622
Phone
(870) 352-5144
Address
PO BOX 729
Deactivation Date
24 September 2021

Doctor Profile

Medical School Name
UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
Secondary Phone
8703523525
Graduation Year
1968 (58 years ago)
PAC ID
3577669605
Group Practice PAC ID
7416869300
Professional Enrollment ID
I20101012001425
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

Provider Addresses for Unknown Individual

  • PO BOX 729

    FORDYCE, AR 717420729

    Phone: (870) 352-5144

    Fax: (870) 352-8498

    Type: Mailing

  • 110 N CLIFTON ST

    FORDYCE, AR 717423025

    Phone: (870) 352-5144

    Fax: (870) 352-8498

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 71742)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEAR81002Urinalysis, manual test15685

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: 7416869300View full group profile
NameSpecialtyState
Nurse PractitionerAR
Nurse PractitionerAR
Nurse PractitionerAR
General PracticeAR
Nurse PractitionerAR
Nurse PractitionerAR
Family PracticeAR

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1376546622.
What does inactive NPI status mean for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Fordyce, Arkansas in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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