Unknown Individual – Family Medicine Physician, NPI 1174581524

Unknown Individual is a healthcare provider. based in Corbin, Kentucky. specializing in Family Medicine Physician. They hold a License No. 28557 (KY). The NPI Number for Unknown Individual is 1174581524

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174581524
Phone
(606) 528-2124
Address
121 BISHOP ST
Deactivation Date
6 May 2021

Doctor Profile

Medical School Name
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Secondary Phone
6065269005
Graduation Year
1990 (36 years ago)
PAC ID
2264332402
Group Practice PAC ID
3870654064
Professional Enrollment ID
I20040113000040
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

  • 121, Bishop Street, Corbin, Whitley County, Kentucky, 40701, United States

    CORBIN, KY 407011702

    Phone: (606) 528-2124

    Fax: (606) 528-8272

    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 40701)

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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 MEDICINEKY90670Pneumococcal vaccine for injection into muscle3030
FAMILY MEDICINEKY93010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report1715

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: 3870654064View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YVA
Nurse PractitionerKY
Family PracticeKY
Nurse PractitionerKY
Physician AssistantKY
Nurse PractitionerKY
-KY
-KY
Nurse PractitionerTN
Physician AssistantKY

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1174581524 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Corbin, Kentucky; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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