Unknown Individual – Family Medicine Physician, NPI 1548464993

Unknown Individual is a healthcare provider. based in Monticello, Arkansas. specializing in Family Medicine Physician. They hold a License No. MD204318 (LA). The NPI Number for Unknown Individual is 1548464993

Main info

Organization
Inactive
39 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548464993
Phone
(870) 367-6246
Address
766 HL ROSS DR
Deactivation Date
22 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8705383355
Graduation Year
1987 (39 years ago)
PAC ID
0345313524
Group Practice PAC ID
5193785590
Professional Enrollment ID
I20170216000714
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 766 HL ROSS DR

    MONTICELLO, AR 71655

    Phone: (870) 367-6246

    Fax: (855) 926-7383

    Type: Location

  • PO BOX 509

    DERMOTT, AR 71638

    Phone: (870) 538-5414

    Fax: (870) 538-5412

    Type: Mailing

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 71655)

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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: 5193785590View full group profile

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1548464993.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Monticello, Arkansas in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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