Unknown Individual – Internal Medicine Physician, NPI 1013996511

Unknown Individual is a healthcare provider. based in Grove, Oklahoma. specializing in Internal Medicine Physician. They hold a License No. 16302 (OK). The NPI Number for Unknown Individual is 1013996511

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013996511
Phone
(918) 786-9088
Address
601 S BROADWAY
Deactivation Date
4 September 2024

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Secondary Phone
9186782282
Graduation Year
1985 (41 years ago)
PAC ID
2860384666
Group Practice PAC ID
6406748367
Professional Enrollment ID
I20040326000701
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 601, South Broadway Street, Grove, Delaware County, Oklahoma, 74344, United States

    GROVE, OK 743443249

    Phone: (918) 786-9088

    Fax: (918) 786-9682

    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 74344)

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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: 6406748367View full group profile
NameSpecialtyState
UNA LORRAINE MCELHANY (ARNP)
-OK
DR. KURT GERARD ZIMMER (DO)
Family PracticeTN
ZACHARY T BECHTOL (MD)
Family PracticeOK
MR. JASON MICHAEL FUSER (P.T.)
Physical Therapist In Private PracticeOK
MEGAN CROWDER (NP-C)
Nurse PractitionerMO
VICKY LYNN WEIDNER (M.D.)
Emergency MedicineOK
STEPHANIE NESVOLD (FNP-C)
Nurse PractitionerMO

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 1013996511.
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 is Unknown Individual's specialty?
The listing groups Unknown Individual with Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Grove, Oklahoma in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."