Unknown Individual – Urology Physician, NPI 1013066398

Unknown Individual is a healthcare provider. based in Oklahoma city, Oklahoma. specializing in Urology Physician. They hold a License No. 24580 (OK). The NPI Number for Unknown Individual is 1013066398

Main info

Organization
Inactive
21 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013066398
Phone
(405) 271-6900
Address
920 STANTON L YOUNG BLVD
Deactivation Date
19 July 2022

Doctor Profile

Medical School Name
UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
Secondary Phone
8174415412
Graduation Year
2005 (21 years ago)
PAC ID
1052582749
Group Practice PAC ID
7719884584
Professional Enrollment ID
I20160928001640

Contacts

Secure Messaging
bpalmer16069@CookChildrens.direct-ci.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 920, Stanton L Young Boulevard, Oklahoma City, Oklahoma County, Oklahoma, 73117, United States

    WP 3150

    OKLAHOMA CITY, OK 731045020

    Phone: (405) 271-6900

    Fax: (405) 271-3118

    Type: Location

  • 512, Northwest 41st Street, Oklahoma City, Oklahoma County, Oklahoma, 73118, United States

    OKLAHOMA CITY, OK 731187026

    Phone:

    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 73104)

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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: 7719884584View full group profile
NameSpecialtyState
GREGORY BARKER
Pediatric Medicine, Cardiac ElectrophysiologyTX
JOHN S DALLAS (MD)
-TX
STEVEN KYLE BRADY (D.O.)
H O S P I T A L I S TVA
DAVID H EWALT (M.D.)
-TX
LAWRENCE SWANSON (MD)
-TX
SARAH A. MACOMBER (CRNA)
Certified Registered Nurse Anesthetist (Crna)TX
DR. MARY COX (M.D.)
Endocrinology, Internal MedicineTX
DR. JASON MILLER REYNOLDS (MD)
Pediatric MedicineTX
KRISTAL L WOLDU (M.D.)
Pediatric Medicine, Cardiovascular Disease (Cardiology)TX
MRS. MONICA PENG (MD)
Pediatric MedicineTX

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1013066398 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Urology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Oklahoma City?
Public fields place Unknown Individual around Oklahoma City, Oklahoma. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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